Bicuspid Aortic Valve-Sparing Root Surgery: What Is the Fate of Residual Aortic Regurgitation?

Objectives: To investigate the incidence and fate of bicuspid aortic valves (BAV) with mild residual aortic regurgitation (AR) mid-term after valve-sparing aortic root replacement (V-SARR) in a retrospective multicenter cohort.

Methods: Between 1994 and 2014, a total of 163 BAV patients (144 males, 44 ± 13 years of age) underwent V-SARR at four aortic surgical centers for AR and/or aortic aneurysm. Combined retrospective data analysis was focused on progression of residual AR and reoperation rates on the aortic valve. Time-related endpoints were analyzed using Kaplan Meier and Log Rank calculations. Average follow-up time was 5 years, cumulating in 445 patient-years.

Results: The majority of 141 patients (86%) underwent a David I procedure with straight tube graft, while 21 (14%) were treated using a David II/Yacoub remodeling operation. Mean prosthesis size used was 30 ± 2 mm. Average AR grade was 2.0 preoperatively, while it was 0.4 directly postoperatively and progressed to 0.6 at latest follow-up. The incidence of mild residual AR directly after V-SARR was 29% (47 patients). The incidence of reoperation on the aortic valve was 6% (10 patients). Only two of the reoperated patients had left the operating room with residual AR. Mild residual AR progressed in 23% of cases. Freedom from reoperation was 94%. In the patients in need of reoperation, the spared BAV had lasted for an average of 9.8 years (median 10.1 years) before valve replacement became necessary.

Conclusion: V-SARR for BAV provides patients with a long time of living without anticoagulation before replacement becomes necessary. Mild residual AR progresses sub-clinically within the first 5 years, and is not a good indicator of need of reoperation in these patients.

No conflict of interest has been declared by the author(s).