title: Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation?
abstract: OBJECTIVE
  To examine the results of root replacement with aortic valve-sparing in patients with bicuspid aortic valve (BAV) or severe aortic regurgitation (AR).
  
  
  METHODS
  Between 2000 and 2009, 102 patients (mean age 47±17.5 years) underwent aortic valve-sparing procedures for ascending aortic aneurysm or dissection. Patients were assigned to three different groups according to the aortic valve pathology: BAV (n=11), tricuspid aortic valve (TAV) with AR less than severe (n=51), and TAV with severe AR (n=40). Remodelling of the aortic root was performed in 28 (27.5%) patients, reimplantation of the aortic valve in 74 (72.5%) and a concomitant cusp repair in 30 (29.4%). All patients were prospectively studied with annual clinical assessment and echocardiography.
  
  
  RESULTS
  The overall actuarial 5-years' survival was 97.8±1.5% without differences between the groups. Actuarial 5-years' freedom from aortic valve-related re-operation was 92.2±3.2% in all patients, 100% in patients with a BAV, 98±1.9% in patients with a TAV and AR less than severe, and 82.7±7.5% in patients with a TAV and severe AR (p=0.07). The overall actuarial freedom from AR, which was more than mild at 5 years was 73.3±7.7%, being significantly (log-rank test: p=0.005) lower for patients presenting with TAV and severe AR (49.9±16.4%).
  
  
  CONCLUSIONS
  The outcome in terms of survival is excellent for all patients after aortic valve-sparing operations. There is no significant difference in terms of re-operation between patients, who presented with BAV or TAV. Re-operation rates are higher for patients who presented with severe AR but these rates do not reach statistical significance. Hence, root replacement with aortic valve-sparing should be offered even in the presence of a BAV or severe AR.
authors.affiliation: German Heart Centre Munich, Department of Cardiovascular Surgery, Clinic at Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany. badiu@dhm.mhn.de
authors.forename: Catalin Constantin
authors.initials: CC
authors.lastname: Badiu
authors.forename: Walter
authors.initials: W
authors.lastname: Eichinger
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Grit
authors.initials: G
authors.lastname: Hermes
authors.forename: Ina
authors.initials: I
authors.lastname: Hettich
authors.forename: Markus
authors.initials: M
authors.lastname: Krane
authors.forename: Robert
authors.initials: R
authors.lastname: Bauernschmitt
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult