Feasibility of valve repair for regurgitant bicuspid aortic valves--an echocardiographic study.
BACKGROUND
There is increasing interest in the role of valve repair for patients with isolated severe aortic regurgitation. Those with bicuspid aortic valves are suggested as most suitable for repair. Morphologic features of these valves that suggest feasibility of repair are not well defined.


METHODS
Perioperative echocardiograms on 132 consecutive patients (mean age 42 +/- 12 years; 94% male), with bicuspid valves and isolated aortic regurgitation undergoing surgery at our institution were reviewed. Seventy-five patients (57%) underwent successful valve repair. Repair was attempted but unsuccessful for another 8 patients (6 intraoperatively and 2 before discharge).


RESULTS
Cusp prolapse was the most common primary mechanism of regurgitation (88 patients [67%]), with 81 patients having primarily eccentrically directed regurgitation. Echocardiographic examination of 72 (55%) had evidence of cusp thickening with 40 (30%) having cusp calcification. By multivariate analysis, an eccentric regurgitant jet direction (odds ratio = 14.3; 95% confidence interval [CI] = 3.4 to 59.6), lack of cusp thickening (odds ratio = 5.9 [1.7 to 20]), lack of cusp calcification (odds ratio = 4.2; [1.1 to 16.7]) and the absence of commissural thickening (odds ratio = 4.8 [1.3 to 16.7]) were independently associated with a greater likelihood of successful valve repair. Greater cusp thickening was the only factor associated with attempted but failed repair.


CONCLUSIONS
Successful repair of regurgitant bicuspid aortic valves was more feasible for those patients with eccentric regurgitant jets, those without cusp or commissural thickening or cusp calcification. Recognition of these features may enhance patient selection and improve procedural outcomes with aortic valve repair.
Nash
Patrick J
PJ
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Vitvitsky
Eugene
E
Li
Jianbo
J
Cosgrove
Delos M
DM
Pettersson
Gosta
G
Grimm
Richard A
RA
D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D004417:Dyspnea / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D016127:Heart Valve Prolapse / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D018579:Patient Selection; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014463:Ultrasonography