title: Repair of bicuspid aortic valves in patients with aortic regurgitation.
abstract: 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.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Elkhoury@chir.ucl.ac.be
authors.forename: Gébrine
authors.initials: G
authors.lastname: El Khoury
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pierard
authors.forename: Robert R
authors.initials: RR
authors.lastname: Verhelst
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Funken
authors.forename: Christine
authors.initials: C
authors.lastname: Watremez
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Valérie
authors.initials: V
authors.lastname: Lacroix
authors.forename: Alain
authors.initials: A
authors.lastname: Poncelet
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
mesh_terms: 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