Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves

Maral Ouzounian, Christopher M. Feindel, Cedric Manlhiot, Carolyn David, Tirone E. David

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number1
StatePublished - Jul 2019
Externally publishedYes


  • aneurysm
  • aortic root
  • aortic valve repair
  • bicuspid aortic valve

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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