Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet

• Published in: European journal of cardio-thoracic surgery Vol. 15; no. 3; pp. 302 - 308
• Main Authors: Casselman, Filip P., Gillinov, A. Marc, Akhrass, Rami, Kasirajan, Vigneshwar, Blackstone, Eugene H., Cosgrove, Delos M.
• Format: Journal Article
• Language: English
• Published: Germany Elsevier Science B.V 01.03.1999
• Subjects: Adolescent; Adult; Aged; Animals; Aortic; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - surgery; Aortic Valve Prolapse - complications; Aortic Valve Prolapse - surgery; Bicuspid; Female; Humans; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Reoperation; Repair; Time Factors; Treatment Outcome; Valve
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(99)00003-2

Objective: To determine the durability of repair of a bicuspid aortic valve with leaflet prolapse, and to identify factors associated with repair failure. Methods: From November 1988 to January 1997, 94 patients with a bicuspid aortic valve and regurgitation from leaflet prolapse had aortic valve repair. In 66 patients, the repair employed triangular resection of the prolapsing leaflet. The remainder underwent mid-leaflet plication of the prolapsing leaflet. Mean age was 38±10 years and 93% were male. Median follow-up was 5.5 years (range 0.2–9 years). Factors associated with aortic valve competence and durability were identified by multivariable logistic and hazard function analyses. Results: Early valve competence was more difficult to achieve in patients with large, poor functioning ventricles (P=0.02). Aortic valve reoperation was necessary in 12 patients that included three re-repairs and nine aortic valve replacements. Freedom from reoperation was 95, 87 and 84% at 1, 5 and 7 years, respectively. The instantaneous risk of reoperation was highest immediately after operation, and fell rapidly to approximately 2% per year and less after 2 years. The only risk factor identified was the presence of residual aortic regurgitation (trace to mild in 35 cases) on immediate intraoperative post-repair transesophageal echocardiography. Late aortic regurgitation did not progress detectably across time (P=0.3). There were no deaths, early or late. Conclusion: Bicuspid aortic valve repair for prolapsing leaflet is a safe procedure with good intermediate-term outcome. However, any residual aortic regurgitation jeopardizes repair durability and initial repair achievement is more difficult in patients with dilated, poor functioning ventricles.