title: Valve configuration determines long-term results after repair of the bicuspid aortic valve.
abstract: BACKGROUND
  Reconstruction of the regurgitant bicuspid aortic valve has been performed for >10 years, but there is limited information on long-term results. We analyzed our results to determine the predictors of suboptimal outcome.
  
  
  RESULTS
  Between November 1995 and December 2008, 316 patients (age, 49±14 years; male, 268) underwent reconstruction of a regurgitant bicuspid aortic valve. Intraoperative assessment included extent of fusion, root dimensions, circumferential orientation of the 2 normal commissures (>160°, ≤160°), and effective height after repair. Cusp pathology was treated by central plication (n=277), triangular resection (n=138), or pericardial patch (n=94). Root dilatation was treated by subcommissural plication (n=100), root remodeling (n=122), or valve reimplantation (n=2). All patients were followed up echocardiographically (cumulative follow-up, 1253 years; mean, 4±3.1 years). Clinical and morphological parameters were analyzed for correlation with 10-year freedom from reoperation with the Cox proportional hazards model. Hospital mortality was 0.63%; survival was 92% at 10 years. Freedom from reoperation at 5 and 10 years was 88% and 81%; freedom from valve replacement, 95% and 84%. By univariable analysis, statistically significant predictors of reoperation were age (hazard ratio [HR]=0.97), aortoventricular diameter (HR=1.24), effective height (HR=0.76), commissural orientation (HR=0.95), use of a pericardial patch (HR=7.63), no root replacement (HR=3.80), subcommissural plication (HR=2.07), and preoperative aortic regurgitation grade 3 or greater. By multivariable analysis, statistically significant predictors for reoperation were age (HR=0.96), aortoventricular diameter (HR=1.30), effective height (HR=0.74), commissural orientation (HR=0.96), and use of a pericardial patch (HR=5.16).
  
  
  CONCLUSIONS
  Reconstruction of bicuspid aortic valve can be performed reproducibly with good early results. Recurrence and progression of regurgitation, however, may occur, depending primarily on anatomic features of the valve.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospitals Homburg, Homburg, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Omar
authors.initials: O
authors.lastname: Abou Issa
authors.forename: Brigitte
authors.initials: B
authors.lastname: Brittner
authors.forename: Stefan
authors.initials: S
authors.lastname: Gräber
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult