title: Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure.
abstract: OBJECTIVE
  Valve-sparing root reimplantation (VSRR) in tricuspid aortic valve (TAV) patients is well established, but in bicuspid aortic valve (BAV) patients, it has been less widely adopted. We assessed whether valve type affects midterm outcomes with VSRR.
  
  
  METHODS
  A retrospective review was performed of 186 patients who underwent an aortic valve-sparing root reimplantation operation between 2004 and 2013. Of these, 129 patients underwent elective VSRR with the David V technique. Outcomes were compared in this cohort by valve type: TAV (n = 89) versus BAV (n = 40).
  
  
  RESULTS
  Demographics were similar in the 2 groups. BAV patients had a higher degree of aortic insufficiency (AI) at presentation (P < .05), and an enlarged preoperative annulus (30 ± 4 vs 28 ± 6 mm, P = .06). All BAV patients required primary leaflet repair (6% in the TAV group; P < .01). Postoperative mortality (0), stroke (0% vs 1%), and pacemaker requirement (0% vs 5%) were similar. Postoperative freedom from AI grade ≥2+ was 100% in the entire cohort, and transvalvular gradients were similar. At follow-up, a 1-year echocardiogram showed higher peak and mean transvalvular gradients in the BAV group (P < .01). One TAV group patient died from an unknown cause. The 5-year actuarial freedom from aortic valve reoperation was 100% versus 97% ± 3% (P = .6). Three patients in the entire cohort have had AI grade >2+ on follow-up (n = 1 in the BAV group; n = 2 in the TAV group).
  
  
  CONCLUSIONS
  Even though BAV patients present with higher AI grade and require concomitant primary valve repair, the VSRR David V technique offers excellent midterm outcomes with both the BAV and TAV valve types.
authors.affiliation: University of Pennsylvania, Philadelphia, Pa. Electronic address: joseph.bavaria@uphs.upenn.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: University of Pennsylvania, Philadelphia, Pa.
authors.forename: Nimesh
authors.initials: N
authors.lastname: Desai
authors.affiliation: University of Pennsylvania, Philadelphia, Pa.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: University of Pennsylvania, Philadelphia, Pa.
authors.forename: Caroline
authors.initials: C
authors.lastname: Komlo
authors.affiliation: University of Pennsylvania, Philadelphia, Pa.
authors.forename: Tyler
authors.initials: T
authors.lastname: Rhode
authors.affiliation: University of Pennsylvania, Philadelphia, Pa.
authors.forename: Tyler
authors.initials: T
authors.lastname: Wallen
authors.affiliation: University of Pennsylvania, Philadelphia, Pa.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
mesh_terms: D000328:Adult; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome