title: Aortic Annulus Diameter Affects Durability of the Repaired Bicuspid Aortic Valve.
abstract: OBJECTIVE
  An investigation was made as to whether the preoperative aortic annular diameter affects the durability of bicuspid aortic valve (BAV) repair in patients who had undergone concomitant root stabilization with subcommissural annuloplasty (SCA) compared to valve-sparing root reimplantation (VSRR).
  
  
  METHODS
  Among a retrospective review of 74 patients who underwent BAV repair between 2005 and 2012,42 had SCA and 32 had VSRR.
  
  
  RESULTS
  The preoperative annulus was similar in the two groups (29 +/- 3 mm for SCA; 30 +/- 4 mm for VSRR, p = 0.3). Postoperative aortic insufficiency (AI) grade > or = 1+ was 100%, but five-year freedom from Al grade >1+ was lower in the SCA group (62 +/- 10% versus 92 +/- 6%, p = 0.02). On univariate analysis, a preoperative annulus 28 mm was predictive of recurrent Al grade >1+ in the SCA group (odds ratio 17.1, p = 0.05), but not in the VSRR group (3.31, p = 0.1). Consequently, SCA patients were evaluated by annular diameter 28 mm (n = 26) versus < or = 27 mm (n = 16). Five-year freedom from AI grade >1+ was lower for the 28 mm SCA subgroup (52 +/- 10% versus +/-3 +/- 6%, p = 0.02). Given this difference between the SCA subgroups, Al grade >1+ in the 28 mm SCA subgroup was compared to VSRR patients with annulus 28 mm ( 28 mm VSRR subgroup, n = 23). The five-year freedom from AI grade >1+ was significantly higher in the 28 mm VSRR subgrou+/- (86 +/- 10% versus 52 +/- 10%, p = 0.02), but simila < or = Sr in the 27 27 m< or = SCA and 527 mm VSRR subgroups (93 +/- 6% versus 100%, p = 0.4).
  
  
  CONCLUSIONS
  For BAV patients with a preoperative aortic annulus 28 mm, SCA results in inferior midterm outcomes. VSRR or alternative annular stabilization techniques should be considered
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Komlo
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Tyler
authors.initials: T
authors.lastname: Rhode
authors.forename: Rohan
authors.initials: R
authors.lastname: Menon
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012008:Recurrence; D012092:Replantation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome