Aortic valve repair versus replacement in bicuspid aortic valve disease.
OBJECTIVE
The study aim was to compare the results of aortic valve repair and replacement with biological valves in adult patients with aortic insufficiency (AI) caused by congenital bicuspid aortic valve (BAV) METHODS: Forty-four patients who had aortic valve repair were matched for age and left ventricular function to 44 patients who had aortic valve replacement (AVR) with biological valves. Patients were followed annually using echocardiography. The mean follow up was 2.6 +/- 2.1 years for the repair group, and 3.5 +/- 2.1 years for the replacement group. Follow up was complete.


RESULTS
There was no operative or late death in either group. Early postoperative echocardiography showed trace or no AI in 35 patients and mild AI in nine who had repair, and trace or no AI in 38 patients and mild AI in five who had AVR. The mean peak systolic gradient was 16.2 +/- 7.6 mmHg for repair and 13.2 +/- 7.2 mmHg for AVR. Four patients who had valve repair and two who had AVR, needed repeat aortic valve surgery because of progressive AI or endocarditis. Freedom from reoperation at five years was 91 +/- 5% for repair and 94 +/- 6% for replacement (p = 0.2), while freedom from moderate or severe AI at five years was 79 +/- 8% for repair and 94 +/- 6% for replacement (p = 0.024). The peak systolic gradient at follow up was 11.7 +/- 6.8 mmHg after repair and 13.3 +/- 9.6 mmHg after AVR (p = 0.4). There were no thromboembolic complications in either group.


CONCLUSIONS
Repair of BAV is feasible in certain patients with AI, but the hemodynamics and clinical outcomes do not appear to be superior to AVR with biological valves during the first five years of follow up.
Davierwala
Piroze M
PM
Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
David
Tirone E
TE
Armstrong
Susan
S
Ivanov
Joan
J
D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology