title: Mid-term results of bicuspid aortic valve repair guided by morphology and function assessment.
abstract: Bicuspid aortic valve (BAV) is frequently associated with aortic insufficiency (AI) due to cusp disease and/or aortic root dilatation. Based on functional classification and morphology, a systematic surgical approach was used for aortic valve repair (AVr).
  
  
  
  From 2004 to 2014, 152 consecutive patients (mean age 55 ± 7 years) with BAV underwent AVr with or without concomitant aortic root surgery. Cusp pathology was treated with central plication in 60 (39.5%) patients, free edge reinforcement in 45 (29.6%), triangular resection in 28 (18.4%) and pericardial patch in 19 (12.5%). Aortic root dilatation was corrected with valve sparing reimplantation in 65 patients. Mean follow-up was 68 ± 36 months.
  
  
  
  In-hospital death was 1.3%. Overall 5-year survival was 88.6 ± 3.6%. Freedom from recurrent ≥ grade 2 AI requiring reoperation at 5-year was 93 ± 3.1%. Five-year freedom from reintervention was 98.4 ± 1.6%, 93.3 ± 6.4% and 82.6 ± 9.6 in the group of patients treated with AVr and reimplantation technique, AVr and subcommissural plasty and AVr repair alone (log-rank P  = 0.005). Commissural orientation <160°, type 2 Siever's BAV and preoperative annulus diameter >29 mm were identified as predictors for recurrent ≥ grade 2 AI.
  
  
  
  BAV repair could be achieved with low incidence of recurrent AI, especially when concomitant annulus stabilization was performed. Systematic preoperative morphological and functional characteristics of the aortic valve should be carried out in order to reduce the risk of repair failure.
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.|Department of Surgery and Cancer, University of Palermo, Palermo, Italy.
authors.forename: Khalil
authors.initials: K
authors.lastname: Fattouch
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari/Honorary research fellow NHLI, Imperial College, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Moscarelli
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Murana
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Dioguardi
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guccione
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari/Honorary research fellow NHLI, Imperial College, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.affiliation: Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari/Honorary research fellow NHLI, Imperial College, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
authors.affiliation: Department of Cardiology, Heart Valve Clinic, University of Liege Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege, Belgium.|Department of Cardiology, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Aortic root replacement; Aortic valve; Echocardiography; Repair