Adult: Aorta
Selective sinus replacement for aortic root repair in bicuspid aortopathy

https://doi.org/10.1016/j.jtcvs.2022.03.019Get rights and content

Abstract

Objectives

To evaluate the results after selective sinus replacement (SSR) for aortic root remodeling in bicuspid aortopathy.

Methods

Among 662 patients who underwent root repair using SSR between 2005 and 2020, there were 114 with bicuspid aortopathy. SSR was performed either as an isolated procedure (31) or as an adjunct to aortic valve repair (83) and was adjusted to the existing aortic annulus diameter rather than a downsized diameter. In valves with asymmetrical commissural orientation, the repair aimed for the achievement of a 180°-commissural orientation.

Results

Abolishment of aortic insufficiency (AI) ≥2+ using root repair alone was only possible in 2 patients with acute-dissection-related AI, yet isolated root repair was also performed in 29 further patients with no/mild AI. All remaining patients with AI ≥2+ presented cusp-related regurgitation and necessitated an additional valve repair. During the mean follow-up of 91 months (range, 13-196), a relevant valve defect (AI ≥3+ in 8, stenosis in 2) occurred in 10 patients (all after combined repair) resulting in an estimated freedom from a relevant aortic valve defect and/or reoperation of 96 ± 2%, 89 ± 4%, and 82 ± 6% at 5, 10, and 12 years, respectively. Echocardiographically, no patient revealed a considerable change of form or size of the repaired root nor was any root reintervention necessary.

Conclusions

Patient-tailored root repair using SSR is a very effective and durable valve-sparing approach for bicuspid aortopathy. Aortic cusp repair is decisive for both abolishment of AI in bicuspid aortopathy and for the functional durability of the repaired aortic valve.

Section snippets

Patients and Methods

Between March 2005 and March 2020, a total of 114 patients with bicuspid aortopathy underwent valve-sparing root repair (VSRR) using SSR exclusively. The average patient age was 50 years (range, 25-75 years). The group included 109 patients with chronic aneurysm and 5 patients with aortic dissection (4 acute), having tubular or root phenotype of aortopathy in 90 and 24 patients, respectively. Symmetrical BAV (symmetrical commissural orientation) was found in 21 patients. None/trivial, mild,

Surgical Results

The average size of the AR was 53 mm and did not differ (53.8 ± 4.9 vs 53.2 ± 6.5, P = .646) among patients with isolated root (31) and combined root and cusp repair (83) and between 93 asymmetrical-BAVs versus 21 symmetrical-BAVs (53.3 ± 5.8 vs 53.7 ± 7.3, P = .366). The same applies to the annulus diameter, which was 30.0 ± 3.0 for the entire cohort and did not differ among patients with root versus root and cusp repair and asymmetrical versus symmetrical BAVs However, in 59 patients with 1

Discussion

VSRR in bicuspid aortopathy is not a frequent procedure, even in high-volume aortic centers. Here, we report on 114 cases, which are less than a fifth of all VSRRs and about a third of all reconstructive BAV repairs performed due to AI during the 12-year study time (290). With this study, which belongs to the largest one-center experiences published to date, we were able to demonstrate that, with the exception of root-related AV insufficiency in aortic dissection, a relevant AI in a bicuspid

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