Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves
- PMID: 31248507
- DOI: 10.1016/j.jtcvs.2018.10.151
Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves
Abstract
Objectives: We sought to compare the outcomes of patients undergoing aortic valve-sparing root replacement with bicuspid versus tricuspid aortic valves.
Methods: A total of 333 consecutive patients (bicuspid aortic valve, n = 45; tricuspid aortic valve, n = 288) underwent valve-sparing root replacement using the reimplantation technique from 1988 to 2012 at a single institution. The primary analysis was performed on a 1:3 bicuspid aortic valve:tricuspid aortic valve propensity-matched dataset to mitigate known differences between these 2 groups. In the matched, dataset, mean age (bicuspid aortic valve: 40 ± 13 years; tricuspid aortic valve: 41 ± 14) and rates of comorbidities were similar between groups. Patients with bicuspid aortic valves were less likely to have Marfan syndrome (bicuspid aortic valve: 9% vs tricuspid aortic valve: 53%, P < .001). Patients were followed prospectively with aortic root imaging for a median of 8.2 (5.3-12.2) years.
Results: Primary cusp repair was required more often in patients with bicuspid aortic valves (bicuspid aortic valve: 79% vs tricuspid aortic valve: 45%, P < .001). A total of 3 operative deaths occurred (bicuspid aortic valve 0% vs tricuspid aortic valve 2%, P = .52). The probability of aortic insufficiency increased significantly over time in both groups (odds ratio, 1.106; 95% confidence interval, 1.033-1.185; P = .004), but there was no significant difference in this increase between the bicuspid aortic valve and tricuspid aortic valve groups (P = .08). Long-term freedom from mortality (P = .20), cumulative incidence of aortic valve reoperation (P = .42), and valve-related events (P = .69) were similar across groups.
Conclusions: In well-selected patients with bicuspid aortic valves and favorable cusp morphology, valve-sparing root replacement offers excellent long-term clinical outcomes.
Keywords: aneurysm; aortic root; aortic valve repair; bicuspid aortic valve.
Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Comment in
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Commentary: Valve-sparing root replacement in patients with bicuspid aortic valves: Long-term data are driving patient selection.J Thorac Cardiovasc Surg. 2019 Jul;158(1):10-11. doi: 10.1016/j.jtcvs.2018.10.103. Epub 2018 Nov 2. J Thorac Cardiovasc Surg. 2019. PMID: 30527781 No abstract available.
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Commentary: Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves: Is the comparison apples to apples?J Thorac Cardiovasc Surg. 2019 Jul;158(1):12-13. doi: 10.1016/j.jtcvs.2018.11.041. Epub 2018 Nov 27. J Thorac Cardiovasc Surg. 2019. PMID: 30655062 No abstract available.
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Discussion.J Thorac Cardiovasc Surg. 2019 Jul;158(1):7-9. doi: 10.1016/j.jtcvs.2018.10.158. J Thorac Cardiovasc Surg. 2019. PMID: 31248515 No abstract available.
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