title: Bicuspidy does not affect reoperation risk following aortic valve reimplantation.
abstract: Aortic valve reimplantation has been shown to be a safe procedure. However, evidences of durability in bicuspid aortic valves (BAVs) are limited in the literature. Between 2002 and 2011, 132 patients (mean age 61 ± 12 years) underwent aortic valve reimplantation. In 24 patients (18%), aortic valve was bicuspid. Mean follow-up was 50 ± 26 months (range 1-102 months) and was 99% complete. In-hospital mortality was 0.8% (1 patient). Survival at 1 and 5 years was 99 and 94%, respectively. Overall freedom from aortic valve reoperation at 1 and 5 years was 96 and 90%, respectively, without significant difference between patients with bicuspid and tricuspid aortic valve. Freedom from aortic valve regurgitation >2+/4+, excluding patients reoperated, was at 1 and 5 years of 100 and 99%, respectively. Patients with valve cusp repair showed a higher rate of aortic valve reoperation; however, only postoperative aortic regurgitation >2+/4+ was significant risk factor for redo procedure at multivariate analysis. Aortic valve reimplantation in BAV without cusp repair provides excellent mid-term results. Further observations and longer follow-up are necessary to determine if BAV sparing, even in the presence of cusps alterations, could allow satisfying durability.
authors.affiliation: Department of Cardiac Surgery, IRCCS Istituto Clinico Humanitas, Rozzano, Italy. pmalvin@tin.it
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Malvindi
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Raffa
authors.forename: Alessio
authors.initials: A
authors.lastname: Basciu
authors.forename: Enrico
authors.initials: E
authors.lastname: Citterio
authors.forename: Antioco
authors.initials: A
authors.lastname: Cappai
authors.forename: Diego
authors.initials: D
authors.lastname: Ornaghi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarelli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Settepani
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome