Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement.
BACKGROUND
In patients with a bicuspid aortic valve presenting with aortic insufficiency (AI) and root aneurysm, we assessed whether outcomes with primary cusp repair with root reimplantation were equivalent to the gold standard Bentall procedures.


METHODS
From 2002 to 2014, 710 patients with bicuspid aortic valve underwent aortic root procedures. Of these, only patients presenting with noncalcified type I bicuspid aortic valve with AI (n = 165) were included to maintain anatomic and physiologic homogeneity between the groups. Aortic stenosis, endocarditis, redo root, and emergency cases were excluded. Patients undergoing valve-sparing root reimplantation (VSRR group, n = 45) were retrospectively compared with those undergoing Bentall root replacement (Bentall group, n = 120).


RESULTS
Patients in the Bentall group were older (52 ± 13 vs 46 ± 12 years; p ≤ 0.01) and had a lower ejection fraction (0.53 ± 0.12 versus 0.58 ± 0.08; p < 0.01), but left ventricular diastolic diameter was similar (58 ± 10 mm versus 57 ± 9 mm; p = 0.5). Thirty-day and in-hospital mortality was zero; in-hospital stroke rate was 0.8% (n = 1) in the Bentall group (0 in the VSRR group; p = 0.54). Permanent pacemaker rate was 6% (n = 7) in the Bentall group (0 in the VSRR group; p = 0.2). On discharge echocardiography, AI grade ≤ 1+ (100%; p = 1) and transvalvular gradients (mean gradient 7 ± 3 versus 6 ± 3 mm Hg; p = 0.14) were similar. Mean follow-up was 7.5 ± 3.2 and 3.4 ± 2.9 years (p < 0.001). There were 14 transient ischemic attacks or stroke events in the Bentall group, and none in the VSRR group. One patient in each group exhibited AI ≥ 3+. Five-year actuarial survival (100% versus 98% ± 2%; p = 0.8) and freedom from aortic reoperation (98% ± 2% versus 100%; p = 0.8) were similar.


CONCLUSIONS
In patients with bicuspid aortic valve AI with root aneurysm, primary cusp repair with root reimplantation achieves equivalent midterm outcomes compared with Bentall root replacement.
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: prashanth.vallabhajosyula@uphs.upenn.edu.
Prashanth
P
Vallabhajosyula
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Wilson Y
WY
Szeto
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Andreas
A
Habertheuer
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Caroline
C
Komlo
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Rita K
RK
Milewski
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Fenton
F
McCarthy
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Nimesh D
ND
Desai
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Joseph E
JE
Bavaria
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D003131:Combined Modality Therapy; D016208:Databases, Factual; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods