title: Repair of regurgitant bicuspid aortic valves: a systematic approach.
abstract: OBJECTIVE
  Patients with bicuspid aortic valves can present with aortic insufficiency caused by cusp disease or the aortic root pathology. We present our 13-year experience with a functional and systematic approach to bicuspid aortic valve repair.
  
  
  METHODS
  Between 1995 and 2008, 122 consecutive patients (mean age, 44 +/- 11 years) with bicuspid aortic valves underwent non-emergency valve repair for isolated aortic insufficiency (43%), aortic root dilatation (14%), or both (43%). Preoperative echocardiography identified aortic dilatation (n = 75), cusp prolapse (n = 96), and cusp restriction (n = 45) as mechanisms of aortic insufficiency. Raphé repair (n = 98) was performed by shaving (21%) or resection with primary closure (60%) or pericardial patch (18%). Functional aortic annuloplasty was performed using subcommissural annuloplasty (n = 51), ascending aortic replacement (n = 17), or aortic root replacement (n = 54) using a reimplantation (76%) or remodeling technique (24%).
  
  
  RESULTS
  There was no operative mortality. Five patients underwent early aortic valve reoperation (3 re-repairs). At discharge, 93% of patients had aortic insufficiency grade 0/1 and 7% of patients had grade 2. Seven additional patients underwent aortic valve reoperation during follow-up (2 re-repairs). Overall survival was 97% +/- 3% at 8 years. At 5 and 8 years follow-up, freedom from aortic valve reoperation was 94% +/- 2% and 83% +/- 5%, respectively, and freedom from aortic valve replacement was 96% +/- 2% and 90% +/- 5%, respectively. Freedom from recurrent aortic insufficiency (>2+) was 94% +/- 3% at 5 years. Freedom from thromboembolism and bleeding was 96% +/- 2% at 8 years.
  
  
  CONCLUSIONS
  A systematic approach to bicuspid aortic valve repair yields good early and midterm results. Repair of bicuspid valves for aortic insufficiency is a feasible and attractive alternative to mechanical valve replacement in young patients.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery Cliniques Universitaires Saint-Luc, Brussels, Belgium. mboodhwani@ottawaheart.ca
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
authors.forename: Laurent
authors.initials: L
authors.lastname: de Kerchove
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012092:Replantation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome