title: Preservation of the bicuspid aortic valve.
abstract: BACKGROUND
  Bicuspid anatomy of the aortic valve is a common reason for aortic regurgitation and is associated with aortic dilatation in more than 50% of patients. We have observed different patterns of aortic dilatation and used different approaches preserving the valve.
  
  
  METHODS
  Between October 1995 and February 2006, a regurgitant bicuspid valve was repaired in 173 patients. The aorta was normal in 57 patients who underwent isolated repair. Aortic dilatation mainly above commissural level (n = 38) was treated by separate valve repair plus supracommissural aortic replacement. In 78 patients, aortic dilatation involved the root and was treated by root remodeling.
  
  
  RESULTS
  Hospital mortality and perioperative morbidity were low in all three groups. Myocardial ischemia was significantly shorter in repair plus aortic replacement than remodeling (p < 0.001). Freedom from aortic regurgitation II or greater at 5 years varied between 91% and 96%. Freedom from reoperation at 5 years was 97% after remodeling, but only 53% after repair plus aortic replacement (p = 0.33). Symmetric prolapse was the most frequent cause for reoperation.
  
  
  CONCLUSIONS
  The long-term stability of bicuspid aortic valve repair is excellent in the absence of aortic pathology. In the presence of aortic dilatation, root remodeling leads to equally stable valve durability. In patients with less pronounced root dilatation, separate valve repair plus aortic replacement may be a less complex alternative. Symmetric prolapse should be avoided if the ascending aorta is replaced.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, Homburg/Saar, Germany. h-j.schaefers@uniklinikum-saarland.de
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.forename: Frank
authors.initials: F
authors.lastname: Langer
authors.forename: Henning F
authors.initials: HF
authors.lastname: Lausberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000209:etiology* / Q000601:surgery*; D001023:Aortic Valve Prolapse / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies