Background: Repair of bicuspid aortic valves (BAVs) for aortic regurgitation (AR) has favorable outcomes, but the impact of natural disease progression on durability of repair is uncertain. We evaluated causes of reoperation and compared outcomes of BAV repair to those of patients undergoing aortic valve replacement (AVR).
Methods: Between January 1993 and December 2016, 113 patients had BAV repair at our institution for significant AR. Operative notes and pathology reports were studied to identify late causes of repair failure. For comparison with AVR, we utilized propensity score weighting with the score derived from preoperative and operative characteristics using gradient boosting machine model.
Results: A total of 26 patients had late AVR after initial repair. Causes of late valve dysfunction included calcification or fibrosis of the cusps (68%), concomitant replacement addressing moderate degree of aortic valve disease to avoid future operation (20%), and cusp prolapse (12%). Pathological evaluation of these excised valves reported calcification and fibrosis in 88% of the valves. Ten-year survival of patients undergoing BAV repair was 91% compared with 90% for patients undergoing AVR with a mechanical valve and 79% for AVR with a bioprosthesis (P = .6). Incidence of reoperation after AVR with a bioprosthesis was similar to risk after repair whereas AVR with mechanical valve showed significant advantage.
Conclusions: Disease progression with calcification or fibrosis is the most common cause of valve failure after initial repair of BAV. Clinical outcomes of BAV repair for severe AR appear superior to AVR with bioprosthesis.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.athoracsur.2020.04.146 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Ascending aorta dilatation for pulmonary atresia with ventricular septal defect: a report of three adult cases.
J Cardiothorac Surg
January 2025
The First Hospital of Tsinghua University, Tsinghua University, Beijing, China.
Background: Patients with pulmonary atresia and ventricular septal defect (PA/VSD) are prone to progressive aortic dilation. However, there are relatively few reports of progressive development of aortic aneurysm or aortic dissection in adult patients who missed early corrective surgery.
Presentation Of Cases: Case 1: A 38-year-old man with PA/VSD and a bicuspid aortic valve (BAV), underwent VSD repair, aortic valve replacement, and PA correction at age 21.
Aortic valve replacement in a bicuspid aortic valve patient followed by reoperation for ascending aorta rupture: a case report.
Front Cardiovasc Med
December 2024
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Bicuspid aortic valve (BAV), the most common congenital cardiac anomaly, predisposes individuals to aortic stenosis and regurgitation due to valve degeneration. Abnormal hemodynamics, arterial wall characteristics, and genetic factors contribute to ascending aorta dilatation, potentially leading to severe complications like aortic dissection. Presently, the most recent guidelines propose that individuals with BAV requiring valve replacement due to valve dysfunction should undergo simultaneous replacement of the ascending aorta when the diameter of aortic dilatation exceeds 4.
View Article and Find Full Text PDFBicuspid Aortic Valve in Children and Young Adults for Cardiologists and Cardiac Surgeons: State-of-the-Art of Literature Review.
J Cardiovasc Dev Dis
October 2024
Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospitals, Sydney St., London SW3 6NP, UK.
Bicuspid aortic valve disease is the most prevalent congenital heart disease, affecting up to 2% of the general population. The presentation of symptoms may vary based on the patient's anatomy of fusion, with transthoracic echocardiography being the primary diagnostic tool. Bicuspid aortic valves may also appear with concomitant aortopathy, featuring fundamental structural changes which can lead to valve dysfunction and/or aortic dilatation over time.
View Article and Find Full Text PDFCurrent evidence of unicuspid aortic valve in young adults: A systematic review and metanalysis.
Curr Probl Cardiol
January 2025
Teknon Medical Center, Heart Institute, Barcelona, Spain.
Article Synopsis
- Unicuspid aortic valve (UAV) is a rare heart condition commonly confused with the more common bicuspid aortic valve (BAV), affecting young adults primarily around 36 years old.
- This study involved a systematic review and meta-analysis of 2953 studies, focusing on the demographic and clinical characteristics of UAV, which often includes associations with conditions like aortic coarctation and Turner syndrome.
- Surgical intervention, primarily aortic valve replacement (AVR), showed high survival rates (95-98%) over ten years, highlighting the need for further research into UAV as a distinct condition apart from BAV.
[Therapeutic results of three-dimensional aortic valve anatomic repair for regurgitant bicuspid aortic valve].
Zhonghua Wai Ke Za Zhi
November 2024
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Cardiovascular Diseases Institute, Shanghai 200032, China.
Article Synopsis
- - The study focused on the surgical technique and outcomes of three-dimensional repair for bicuspid aortic valve (BAV) in patients experiencing aortic regurgitation (AR), examining 130 patients from August 2021 to December 2023 at Zhongshan Hospital, Fudan University.
- - The repair involved modified aortic root reconstruction and resulted in varying degrees of regurgitation post-surgery, with 62.3% of patients showing trace regurgitation immediately after the operation, and 51.8% displaying trace regurgitation during follow-up.
- - Throughout the follow-up period averaging 5.5 months, no patient died, highlighting the technique's potential safety and efficacy for patients with BAV
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!