Reimplantation for annular stabilization in bicuspid aortic valve repair

Abstract

Objectives

To review the outcomes of bicuspid aortic valve repair with the reimplantation technique.

Patients and methods

From 2006 to 2018, 46 patients with bicuspid aortic valve underwent the reimplantation procedure for aortic valve repair. Those patients were included in this study. The mean age was 45 ± 15 years and 44 were male. Preoperative echocardiography showed a mean ventriculoaortic junction diameter of 28 ± 3 mm. The mean diameter at the sinus of Valsalva was 41 ± 9 mm. The minimum cusp height was 19 ± 3 mm. Regarding cusp repair technique, central plication was used in 45 patients, free margin reinforcement in 10 patients, and patch repair in 4 patients. Follow-up was performed by annual echocardiography.

Results

There were no hospital deaths. All patients were found with either no/trivial or mild AR on postoperative transesophageal echocardiography. The postoperative ventriculoaortic junction diameter was 23 ± 2 mm and 83 ± 17% preoperatively. Freedom from moderate AR was 85 ± 6% at 5 years, and freedom from reoperation was 93 ± 4% at 5 years.

Conclusions

Reimplantation for bicuspid aortic valve repair showed acceptable mid-term outcomes.

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References

  1. 1.

    Sarsam MA, Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg. 1993;105:435–8.

    CAS  Article  Google Scholar 

  2. 2.

    David TA, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–22.

    CAS  Article  Google Scholar 

  3. 3.

    Langer F, Aicher D, Kissinger A, Wendler O, Lausberg H, Fries R, Schäfers HJ. Aortic valve repair using a differentiated surgical strategy. Circulation. 2004;110:II67–II73.

    Article  Google Scholar 

  4. 4.

    Tanaka H, Takahashi H, Inoue T, Matsueda T, Oda T, Abe N, et al. Which technique of cusp repair is durable in reimplantation procedure? Eur J Cardiothorac Surg. 2017;52:112–7.

    Article  Google Scholar 

  5. 5.

    Hanke T, Chartos EI, Stierle U, Robinson D, Gorski A, Sievers HH. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery. J Thorac Cardiovasc Surg. 2009;137:314–9.

    Article  Google Scholar 

  6. 6.

    2017 ESC/EACTS Guidelines for the management of valvular heart disease. The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017;38:2739–86.

    Article  Google Scholar 

  7. 7.

    Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504–10.

    Article  Google Scholar 

  8. 8.

    de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde JL, Noirhomme P, et al. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg. 2011;142:1430–8.

    Article  Google Scholar 

  9. 9.

    Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.

    Article  Google Scholar 

  10. 10.

    Schäfers HJ, Schmied W, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146:269–74.

    Article  Google Scholar 

  11. 11.

    Vriz O, Aboyans V, D'Andrea A, Ferrara F, Acri E, Limongelli G, et al. Normal values of aortic root dimensions in healthy adults. Am J Cardiol. 2014;114:921–7.

    Article  Google Scholar 

  12. 12.

    de Kerchove L, Boodhwani M, Glineur D, Noirhomme P, El Khoury G. A new simple and objective method for graft sizing in valve-sparing root replacement using the reimplantation technique. Ann Thorac Surg. 2011;92:749–51.

    Article  Google Scholar 

  13. 13.

    David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg. 2006;132:347–54.

    Article  Google Scholar 

  14. 14.

    Ikeno Y, Tanaka H. Okita Y Intraoperative aortic root pressure study for quantitative assessment of aortic regurgitation during valve-sparing root replacement: a preliminary report. J Thorac Cardiovasc Surg. 2018;156:1399–401.

    Article  Google Scholar 

  15. 15.

    Schneider U, Aicher D, Miura Y, Schäfers HJ. Suture annuloplasty in aortic valve repair. Ann Thorac Surg. 2016;101:783–5.

    Article  Google Scholar 

  16. 16.

    de Kerchove L, Mastrobuoni S, Boodhwani M, Astarci P, Rubay J, Poncelet A, et al. The role of annular dimension and annuloplasty in tricuspid aortic valve repair. Eur J Cardiothorac Surg. 2016;49:428–37.

    Article  Google Scholar 

  17. 17.

    Lansac E, Di Centa I, Sleilaty G, Lejeune S, Khelil N, Berrebi A. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg. 2016;50:350–60.

    Article  Google Scholar 

  18. 18.

    Mazzitelli D, Fischlein T, Rankin JS, Choi YH, Stamm C, Pfeiffer S, et al. Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg. 2016;49:987–93.

    Article  Google Scholar 

  19. 19.

    Nawaytou O, Mastrobuoni S, de Kerchove L, Baert J, Boodhwani M, El Khoury G. Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus. J Thorac Cardiovasc Surg. 2018;156(2):590–7.

    Article  Google Scholar 

  20. 20.

    Nishimura RA, Bonow RO, Guyton RA, Sundt TM III. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg. 2016;151:959–66.

    Article  Google Scholar 

  21. 21.

    Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, Kobayashi J. Thoracic and cardiovascular surgery in Japan during 2014: annual report by The Japanese Association for ThoracicSurgery. Gen Thorac Cardiovasc Surg. 2016;64:665–97.

    Article  Google Scholar 

  22. 22.

    Wang M, Furnary AP, Li HF, Grunkemeier GL. Bioprosthetic aortic valve durability: a meta-regression of published studies. Ann Thorac Surg. 2017;104:1080–7.

    Article  Google Scholar 

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We received no funding support for this study.

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Correspondence to Yutaka Okita.

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Hiroshi Tanaka declares no conflict of interest. Kenji Okada declares no conflict of interest. Yutaka Okita declares no conflict of interest.

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Tanaka, H., Okada, K. & Okita, Y. Reimplantation for annular stabilization in bicuspid aortic valve repair. Gen Thorac Cardiovasc Surg (2020). https://doi.org/10.1007/s11748-020-01453-9

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Keywords

  • Bicuspid aortic valve repair
  • Reimplantation
  • Root replacement