title: Valve-preserving root replacement in bicuspid aortic valves.
abstract: OBJECTIVE
  Bicuspid aortic valve anatomy is associated with aortic root aneurysm in a relevant proportion of patients. These patients require root replacement for prognostic reasons, and the valve may be preserved. The objective of this analysis is to analyze the early and late outcomes of root remodeling for bicuspid aortic valve.
  
  
  METHODS
  Between November 1995 and December 2009, 153 patients (133 male) were treated by root remodeling in the presence of a bicuspid aortic valve. Acute dissection was present in 6 individuals. In 137 instances, additional correction of cusp pathology was achieved by plication (n = 119), triangular resection (n = 59), and implantation of a pericardial patch (n = 27). Follow-up ranges from 3 months to 14.5 years (mean, 4.9 ± 3.8 years; cumulative, 757 years) and is complete in 99.3%.
  
  
  RESULTS
  One patient died of intracranial hemorrhage in the hospital (mortality 0.7%). Survival at 5 and 10 years was 99% and 91%, respectively. Seven patients required reoperation for stenosis (n = 1) or recurrent aortic insufficiency (n = 6) between 1 month and 11 years postoperatively. The aortic valve was re-repaired in 2 cases. Freedom from reoperation at 5 and 10 years was 95%; freedom from valve replacement was 97%. Freedom from valve-related complications was 91% at 5 and 10 years.
  
  
  CONCLUSIONS
  Root remodeling for aortic root aneurysm in the presence of a bicuspid aortic valve can be performed with a low morbidity and mortality. The long-term stability of the reconstructed aortic valve is excellent if normal valve configuration is achieved. The occurrence of late stenosis seems to be rare, and freedom from valve-related complications is high.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany. h-j.schaefers@uks.eu
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Peter
authors.initials: P
authors.lastname: Fries
authors.forename: Brigitte
authors.initials: B
authors.lastname: Brittner
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D015150:Echocardiography, Doppler; D005260:Female; D005858:Germany; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome