title: Impact of Cusp Repair on Reoperation Risk After the David Procedure.
abstract: BACKGROUND
  We assessed whether additional cusp repair during valve-sparing aortic root replacement affects the echocardiographic mid-term results; a subgroup analysis among patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) was performed.
  
  
  METHODS
  Between June 2002 and May 2015, 157 consecutive patients underwent valve-sparing aortic root replacement with the David technique. Thirty patients (19%) had BAV. In 19 patients (12%), cusp motion or anatomic abnormalities contributed in determining aortic regurgitation requiring an additional cusp repair. Mean follow-up was 7 ± 3.4 years.
  
  
  RESULTS
  The cumulative 1-, 5-, and 12-year survival rates were 98%, 94%, and 90%, respectively. Fourteen patients (9%) required aortic valve replacement during follow-up. In 2 patients the underlying cause was bacterial endocarditis. Freedom from aortic valve reoperation was 96% at 1 year, 92% at 5 years, and 89% at 12 years. Reoperation rate was significantly higher (p < 0.001) in patients who received leaflet repair compared with patients who did not, with a freedom from reoperation at 8 years of 58% versus 94%. Among patients with BAV, those who did not require cusp repair had a freedom from reoperation at 8 years of 94%, with a significant difference compared with patients who received cusp repair (p = 0.04). Cusp repair did not affect reoperation risk in patients with tricuspid aortic valve.
  
  
  CONCLUSIONS
  Adjunctive cusp repair seems to affect the mid-term reoperation risk in patients with BAV and not in patients with tricuspid aortic valve. We recommend caution in using this technique in case of asymmetric BAV requiring cusp repair.
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Electronic address: fabrizio.settepani@humanitas.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Settepani
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Antioco
authors.initials: A
authors.lastname: Cappai
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Basciu
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barbone
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Moz
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Citterio
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Ornaghi
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarelli
mesh_terms: D000328:Adult; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002114:Calcinosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk