Long-term Outcomes After Bicuspid Aortic Valve Repair With An External Aortic Ring Annuloplasty
MUSTAFA ZAKKAR, vito D. Bruno, Sarah Pousset, Isabelle Di Cante, Jean Luc Monnin, Nizar Khelil, Mathieu Debauchez, Emmanuel Lansac.
Institut Mutualiste Montsouris, PARIS, France.
OBJECTIVE: Despite being reparable in case of dystrophic aortic insufficiency, bicuspid aortic valve remain mostly replaced. We present long term outcomes of a standardized approach of bicuspid aortic valve repair using external ring annuloplasty adapted to each dystrophic phenotype (root, tubular, normal) of the aorta.
METHODS: Data collected from the Aortic Valve repair InternATIOnal Registry (AVIATOR). between 2003-2017.
RESULTS: 152 patients with bicuspid aortic valve underwent surgery of whom 83 patients had valve sparing remodelling with external ring annuloplasty, 24 patients had valve repair with external ring annuloplasty and ascending aortic replacement, 31 patients had isolated aortic valve repair with single external ring annuloplasty at the annulus level and 14 patients had isolated aortic valve repair with double ring annuloplasty at the annulus and STJ levels mean age was 46.5±12.8 years, and 92 (60.5%) patients had > 2 AI. Over all 30 days mortality was 0.7%, 1 patient (0.7%) had postoperative stroke and 3 (2%) required PPM post-surgery with no differences between the groups. Long-term follow up demonstrated 91% overall survival, 88% freedom from aortic related re-intervention and 86% freedom from AI>2 at 8 years. Sub-analysis demonstrated that the recurrence of significant AI> 2 and aortic related re-intervention were driven by the isolated aortic ring repair with single annuloplasty (63% vs 100%, p<0.001 and 70% vs 99%, p<0.001 respectively).
CONCLUSIONS: Bicuspid aortic valve repair as part of root valve sparing surgery or isolated leaflet repair with external ring annuloplasty is associated with excellent long-term outcomes. Restoration of the annulus /STJ ratio is a key factor for long lasting bicuspid valve repair.
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