Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves.
OBJECTIVES
We sought to compare the outcomes of patients undergoing aortic valve-sparing root replacement with bicuspid versus tricuspid aortic valves.


METHODS
A total of 333 consecutive patients (bicuspid aortic valve, n = 45; tricuspid aortic valve, n = 288) underwent valve-sparing root replacement using the reimplantation technique from 1988 to 2012 at a single institution. The primary analysis was performed on a 1:3 bicuspid aortic valve:tricuspid aortic valve propensity-matched dataset to mitigate known differences between these 2 groups. In the matched, dataset, mean age (bicuspid aortic valve: 40 ± 13 years; tricuspid aortic valve: 41 ± 14) and rates of comorbidities were similar between groups. Patients with bicuspid aortic valves were less likely to have Marfan syndrome (bicuspid aortic valve: 9% vs tricuspid aortic valve: 53%, P < .001). Patients were followed prospectively with aortic root imaging for a median of 8.2 (5.3-12.2) years.


RESULTS
Primary cusp repair was required more often in patients with bicuspid aortic valves (bicuspid aortic valve: 79% vs tricuspid aortic valve: 45%, P < .001). A total of 3 operative deaths occurred (bicuspid aortic valve 0% vs tricuspid aortic valve 2%, P = .52). The probability of aortic insufficiency increased significantly over time in both groups (odds ratio, 1.106; 95% confidence interval, 1.033-1.185; P = .004), but there was no significant difference in this increase between the bicuspid aortic valve and tricuspid aortic valve groups (P = .08). Long-term freedom from mortality (P = .20), cumulative incidence of aortic valve reoperation (P = .42), and valve-related events (P = .69) were similar across groups.


CONCLUSIONS
In well-selected patients with bicuspid aortic valves and favorable cusp morphology, valve-sparing root replacement offers excellent long-term clinical outcomes.
['Ouzounian|Maral|M|', 'Feindel|Christopher M|CM|', 'Manlhiot|Cedric|C|', 'David|Carolyn|C|', 'David|Tirone E|TE|']
D000328:Adult D001011:Aorta D001014:Aortic Aneurysm D001021:Aortic Valve D000082882:Bicuspid Aortic Valve Disease D005260:Female D006349:Heart Valve Diseases D006801:Humans D008297:Male D012086:Reoperation D016896:Treatment Outcome D014261:Tricuspid Valve D058017:Vascular Grafting
bicuspid aortic valve aortic root aneurysm aortic valve repair