Repair of bicuspid aortic valves in patients with aortic regurgitation.
BACKGROUND
Bicuspid aortic valve regurgitation can be caused by a defect in the valve itself or by dysfunction of one or more components of the aortic root complex. A successful repair thus requires correction of all aspects of the problem simultaneously. We review our experience addressing both the valve and the aortic root when correcting bicuspid valve regurgitation.


RESULTS
Between 1996 and 2004, we treated 68 patients for aortic regurgitation. Thirty patients had isolated aortic regurgitation, and 38 had an associated ascending aortic aneurysm. All patients were treated using a standardized and integrated surgical technique, which included resection of the median raphe or leaflet plication, subcommissural annuloplasty, reinforcement of the leaflet free edge, and sinotubular junction plication. In the 38 patients with proximal aortic dilatation, reimplantation or remodeling of the aortic root was performed. Immediate postoperative echocardiography showed grade < or = 1 aortic regurgitation in all patients. Three patients nonetheless needed an early re-operation because of recurrent regurgitation. No hospital mortality was observed. At a mean follow-up of 34 months after surgery, all patients were in New York Heart Association (NYHA) class 1 or 2. Two patients needed a re-operation (23 and 92 months, respectively). Echocardiographic follow-up showed no progression of the regurgitation in 58 surviving patients. Four patients progressed to grade 2 regurgitation.


CONCLUSIONS
Our data indicate that regurgitant bicuspid aortic valves, whether alone or in association with a proximal aortic dilatation, can be repaired successfully provided that both the valve and the aortic root problems are treated simultaneously.
El Khoury
Gébrine
G
Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Elkhoury@chir.ucl.ac.be
Vanoverschelde
Jean-Louis
JL
Glineur
David
D
Pierard
Frédéric
F
Verhelst
Robert R
RR
Rubay
Jean
J
Funken
Jean-Christophe
JC
Watremez
Christine
C
Astarci
Parla
P
Lacroix
Valérie
V
Poncelet
Alain
A
Noirhomme
Philippe
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014463:Ultrasonography