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Re-Repair of the Bicuspid Aortic Valve
Ulrich Schneider, MD, Tristan Ehrlich, MD, Irem Karliova, MD, Christian Giebels, MD, Hans-Joachim Schäfers, MD.
Saarland University Medical Center, Homburg, Germany.

OBJECTIVE: Repair of the bicuspid aortic valve (BAV) has led to good long-term stability if done with respect to all components of aortic valve and root. Failure may occur with the need for reoperation consisting of replacement or re-repair. We analyzed our results after re-repair of failed BAVs.
METHODS: Between 2004 and 2015, 32 patients (mean age 41±13 years, 96.6% male) underwent BAV re-repair for recurrent aortic regurgitation. In 15 patients (46.9%), valve failure was caused by suboptimal aortic root or valve configuration. At reoperation, it was corrected by modification of root dimensions (i. e. aortic replacement/annuloplasty) or valve morphology. Other causes for reoperation were pericardial patch failure (n=6, 18.8%), cusp restriction (n=3, 9.4%), fenestrations (n=2, 6.3%), cusp calcification (n=2, 6.3%), aortic dissection (n=1, 3.1%), recurrent prolapse (n=1, 3.1%), endocarditis (n=1, 3.1%) and unrecognized unicuspid valve morphology (n=1, 3.1%).
RESULTS: No patient died in hospital, survival at 5 and 10 years was 96% and 84% respectively. During follow-up, 15 patients (46.9%) required repeat aortic valve reintervention. Freedom from reoperation at 5 and 10 years was 59% and 45%. Best repair durability was observed after root or valve modification with 5 and 10-year freedom from reoperation of 74%. After re-repair for patch failure, freedom from reoperation was 33% at 5 and 0% at 10 years (p=0.015). All BAVs re-repaired for cusp calcification or fenestrations and due to unrecognized unicuspid morphology failed during follow-up. After re-repair for cusp restriction, only one (33%) patient showed stable valve function over time. All other patients (n=3) required no further BAV intervention.
CONCLUSIONS: Re-repair of the BAV is feasible with good mid-term stability if done for modification of aortic root dimensions or BAV morphology. After re-repair for patch failure or cusp pathologies, an inacceptable durability was observed. In those instances, valve replacement should be performed.


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