TY - JOUR
T1 - Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves
AU - Ouzounian, Maral
AU - Feindel, Christopher M.
AU - Manlhiot, Cedric
AU - David, Carolyn
AU - David, Tirone E.
N1 - Publisher Copyright:
© 2018 The American Association for Thoracic Surgery
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - aneurysm
KW - aortic root
KW - aortic valve repair
KW - bicuspid aortic valve
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U2 - 10.1016/j.jtcvs.2018.10.151
DO - 10.1016/j.jtcvs.2018.10.151
M3 - Article
C2 - 31248507
AN - SCOPUS:85067586368
VL - 158
SP - 1
EP - 9
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 1
ER -