Valve-sparing surgery for bicuspid aortic valve: intermediate results and predictors of aortic regurgitation

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OBJECTIVE

To analyze the early and mid-term results of valve-sparing interventions on the aortic valve, including concomitant ascending aorta repair in adults with bicuspid aortic valve.

MATERIAL AND METHODS

The study retrospectively included 65 patients with bicuspid aortic valve and indications for surgery for aortic insufficiency and/or ascending aorta aneurysm. All patients were treated at the Meshalkin National Medical Research Center for the period 2016—2020. All patients underwent aortic valve repair and, if necessary, aortic root reconstruction.

RESULTS

In-hospital and long-term mortality was absent. The mean follow-up period was 17.2±1.8 months. In the postoperative period, 4 (6.2%) patients had moderate aortic regurgitation, 2 (3.1%) patients — severe aortic regurgitation. There were no cases of redo surgery. According to multivariate regression analysis, two significant risk factors of aortic regurgitation recurrence were identified: Sievers type 2 aortic valve (p=0.003, HR 33.44) and RN valve type (p=0.001, HR 17.43). Freedom from aortic regurgitation recurrence after 1 and 3 years was 100% and 78.3%, respectively.

CONCLUSION

Aortic valve repair in patients with bicuspid aortic valve is absolutely safe and ensures high freedom from aortic regurgitation recurrence. This method of surgical treatment should be widely introduced into clinical practice.

Keywords:

bicuspid aortic valve

aortic valve disease

aortic aneurysm

aortopathy

Authors:

Karadzha A.V.

Meshalkin National Medical Research Center

Bogachev-Prokofiev A.V.

Meshalkin National Medical Research Center

SPIN RSCI: 4448-6999
Scopus AuthorID: 55846629000
ResearcherID: L-7881-2014
ORCID: 0000-0003-4625-4631

Sharifulin R.M.

Meshalkin National Medical Research Center

SPIN RSCI: 2147-0630
Scopus AuthorID: 57188660699
ResearcherID: F-6318-2017
ORCID: 0000-0002-8832-2447

Chernyavskiy A.M.

National Medical Research Center

Received:

22.03.2021

Accepted:

07.04.2021

List of references:

Liu T, Xie M, Lv Q, Li Y, Fang L, Zhang L, Deng W, Wang J. Bicuspid aortic valve: an update in morphology, genetics, biomarker, complications, imaging diagnosis and treatment. Front. Physiol. 2019;9:1921. https://doi.org/10.3389/fphys.2018.01921
Dzemeshkevitch SL, Ivanov VA, Charchyan ER, Evseev EP, Frolova YuV, Lugovoy AN, Fedulova SV, Khovrin VV, Bukaeva AA, Zaklyazminskaya EV. Bicuspid aortic valve (development of insight into valvulopathies). Russian Journal of Cardiology. 2014;5(109):49-54. (In Russ.). https://doi.org/10.15829/1560-4071-2014-5-49-54
Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55(25):2789-2800. https://doi.org/10.1016/j.jacc.2009.12.068
Sultan I, Komlo CM, Bavaria JE. How I Teach a Valve-Sparing Root Replacement. Ann Thorac Surg 2016;101:422-425. https://doi.org/10.1016/j.athoracsur.2015.12.035
Schäfers HJ, Aicher D, Langer F, Lausberg HF. Preservation of the bicuspid aortic valve. Ann Thorac Surg. 2007;83;2:740-745. https://doi.org/10.1016/j.athoracsur.2006.11.017
Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med. 2014;370;20:1920-1929. https://doi.org/10.1056/NEJMra1207059
Schneider U, Hofmann C, Schöpe J. Long-term Results of Differentiated Anatomic Reconstruction of Bicuspid Aortic Valves. JAMA Cardiol. 2020;5:12:1-8. https://doi.org/10.1001/jamacardio.2020.3749
Habertheuer A, Milewski RK, Bavaria JE, Siki M, Freas M, Desai N, Szeto W, Ram C, Hu R, Vallabhajosyula P. Predictors of recurrent aortic insufficiency in type I bicuspid aortic valve repair. Ann Thorac Surg. 2018;106;5:1316-1324. https://doi.org/10.1016/j.athoracsur.2018.06.026
Schneider U, Feldner SK, Hofmann C, Schöpe J, Wagenpfeil S, Giebels C, Schäfers HJ. Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg. 2017;153;4:65-71. https://doi.org/10.1016/j.jtcvs.2016.12.030
Ouzounian M, Feindel CM, Manlhiot C, David C, David TE. Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves. The Journal of Thoracic and Cardiovascular Surgery. 2018. https://doi.org/10.1016/j.jtcvs.2018.10.151
Baumgartner H, Falk V, Bax JJ, et al. ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38;36:2739-2791. https://doi.org/10.1093/eurheartj/ehx391
Sharifulin RM, Demin II, Astapov DA, Afanasyev AV, Pivkin AN, Ovcharov MA, Sapegin AV, Bogachev-Prokophiev AV. Aortic root reconstruction in bicuspid aortic valve. Russ Jour of Card and Cardiovasc Surg = Kard i serd-sosud khir. 2020;13:3:213-223. (In Russ.). https://doi.org/10.17116/kardio202013031213
Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg. 2007;133:5:1226-1233. https://doi.org/10.1016/j.jtcvs.2007.01.039
Arnaoutakis GJ, Sultan I, Siki M, Bavaria JE. Bicuspid aortic valve repair: systematic review on long-term outcomes. Annals of Cardiothoracic Surgery. 2019;8:3:302-312. https://doi.org/10.21037/acs.2019.05.08
Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schafers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504-510. https://doi.org/10.1016/j.athoracsur.2016.06.072
Lansac E, Di Centa I, Sleilaty G, Lejeune S, Berrebi A, Zacek P et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033-1042. https://doi.org/10.1016/j.jtcvs.2016.12.031
de Kerchove L, Mastrobuoni S, Froede L, Tamer S, Boodhwani M, Van Dyck M, El Khoury G, Schäfers HG. Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification. Eur J Cardiothorac Surg. 2019; ezz033. https://doi.org/10.1093/ejcts/ezz033
Aicher D, Langer F, Kissinger A, Lausberg H, Fries R, Schäfers HG. Valve-sparing aortic root replacement in bicuspid aortic valves: a reasonable option? J Thorac Cardiovasc Surg. 2004;128;5:662-668. https://doi.org/10.1016/j.accreview.2005.02.004
Bierbach BO, Aicher D, Issa OA, Bomberg H, Gräber S, Glombitza P, Schäfers HJ. Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg. 2010;38;4:400-406. https://doi.org/10.1016/j.ejcts.2010.01.060
Lansac E, de Kerchove L. Aortic valve repair techniques: state of the art. Eur J Cardiothorac Surg. 2018;53:1101-1108. https://doi.org/10.1093/ejcts/ezy176
El Khoury G, Vanoverschelde JL, Glineur D, Pierard F, R Verhelst R, Rubay J, Funken JC, Watremez C, Astarci P, Lacroix V, Poncelet A, Noirhomme P. Repair of bicuspid aortic valves in patients with aortic regurgitation. Circulation. 2006;4:114(1 suppl):610-616. https://doi.org/10.1161/CIRCULATIONAHA.105.001594
Ehrlich T, de Kerchove L, Vojacek J, Boodhwani M, El-Hamamsy I, De Paulis R, Schäfers HJ. State-of-the art bicuspid aortic valve repair in 2020. Progress in Cardiovascular Diseases. https://doi.org/10.1016/j.pcad.2020.04.010
Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HG. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123;2:178-185. https://doi.org/10.1161/circulationaha.109.934679
Schneider U, Schmied W, Aicher D, Giebels C, Winter L, Schäfers HG. Sinus Plication to Improve Valve Configuration in Bicuspid Aortic Valve Repair-Early Results. Ann Thorac Surg. 2017;103;2:580-585. https://doi.org/10.1016/j.athoracsur.2016.06.064
Bavaria J, Vallabhajosyula P, Komlo C, Szeto WY. Valve-sparing aortic root reimplantation and cusp repair in bicuspid aortic valve: with aortic insufficiency and root aneurysm. Ann Cardiothorac Surg. 2013;2;1:127-129. https://doi.org/10.3978/j.issn.2225-319X.2013.01.18
Michelena HI, Khanna AD, Mahoney D, Margaryan E, Topilsky Y, Suri R, Eidem B, Edwards W, Sundt 3rd T, Enriquez-Sarano M. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA. 2011;306;10:1104-1112. https://doi.org/10.1001/jama.2011.1286
Della Corte A, Bancone C, Quarto C, Dialetto G, Covino FE, Scardone M, Caianiello G, Cotrufo M. Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression. Eur J Cardiothorac Surg. 2007;31;3:397-404. https://doi.org/10.1016/j.ejcts.2006.12.006
Kayatta MO, Leshnower BG, McPherson L, Binongo J, Lasanajak Y, Chen E. Valve-sparing root replacement provides excellent midterm outcomes for bicuspid valve aortopathy. Ann Thorac Surg. 2019;107;2:499-504. https://doi.org/10.1016/j.athoracsur.2018.08.011
Karliova I, Schneider U, Ehrlich T, Schäfers HJ. Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg. 2020;109;3:728-735. https://doi.org/10.1016/j.athoracsur.2019.07.025
Igarashi T, Matsushima S, Shimizu A, Ehrlich T, Karliova I, Schäfers HG. Bicuspidization and Annuloplasty Provide a Functioning Configuration to the Unicuspid Aortic Valve. Ann Thorac Surg. 2020;110;1:111-119. https://doi.org/10.1016/j.athoracsur.2019.10.023

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