title: Root remodeling and aortic valve repair for unicuspid aortic valve.
abstract: BACKGROUND
  Unicuspid aortic valve (UAV) anatomy is occasionally encountered in adolescents or young adults and not infrequently associated with aneurysm of the ascending aorta and aortic root. To manage both defects without aortic valve replacement we propose a combination of remodeling of the aortic root combined with bicuspidization of the UAV.
  
  
  METHODS
  Between 1 December 2007 and November 2013, 25 patients (23 males; mean age, 38 ± 12 years; range, 21 to 65 years) with aortic regurgitation as a result of UAV and aortic root dilatation underwent remodeling of the aortic root and bicuspidization of the UAV. The dilated aortic root tissue was resected, leaving the wall adjacent to the normal commissure and at 180 degrees orientation and similar height for the new commissure. The graft was configured to create two symmetric tongues of graft and sutured to the remnants of the aortic root wall. The dysplastic right coronary cusp was resected, and autologous pericardial patches augmented the deficiency of cusp tissue between the left and noncoronary cusps. A suture annuloplasty was used in 20 cases. All patients were followed clinically and echocardiographically at 3, 6, and 12 months and at yearly intervals. Cumulative follow-up was 677 months (mean, 27 ± 18 months).
  
  
  RESULTS
  No early or late death occurred. Intraoperative echocardiography revealed minimal or no aortic regurgitation in all patients; at discharge, systolic mean gradient was 6 ± 3 mm Hg. There was no bleeding or thromboembolic event during the follow-up. One patient exhibited endocarditis and underwent reoperation. Two patients experienced relevant recurrent aortic regurgitation for limited suture dehiscence between the patch and the cusp and were reoperated on between 16 and 32 months postoperatively. One patient underwent biologic valve replacement, and two valves were re-repaired. At 5 years, freedom from reoperation and aortic valve replacement was 81% and 91%, respectively.
  
  
  CONCLUSIONS
  In the presence of UAV and aortic root dilatation, the concept of valve bicuspidization and root remodeling can be applied with satisfactory hemodynamic results. The hemodynamic function of an aortic valve preserved by this concept is good. If sufficient stability can be achieved, aortic valve replacement can be avoided in young patients with aortic regurgitation caused by UAV and root aneurysm.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Franciulli
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.affiliation: Department of Pediatric Cardiology, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Rädle-Hurst
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Rodionycheva
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany. Electronic address: h-j.schaefers@uks.eu.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult