OBJECTIVE

To analyze the results of aortic valve (AV) repair during David procedure in patients with bicuspid AV and aortic root aneurysm.

MATERIAL AND METHODS

David procedure was performed in 123 patients with aortic root aneurysm and aortic insufficiency between September 2015 and January 2022. Bicuspid AV was observed in 24 (19.5%) patients. The follow-up period ranged from 1 to 6 years (mean 2.5±1.3). We analyzed early and mid-term postoperative results (length and depth of leaflet coaptation, pressure gradient, redo surgery, survival, and overall mortality).

RESULTS

Bicuspid AV Sievers type 1 (L-R) was diagnosed in 17 (70.8%) patients, type 0 in 5 (20.8%) patients, type 1 (R-N) in 2 (8.3%) patients. Ten (41.6%) patients had aortic insufficiency grade 3, 7 (29.1%) patients — grade 4. Other ones had aortic regurgitation grade ≤2. Aortic valve repair was performed in 21 (87.5%) patients: 19 (90.4%) — central plication, 7 (33.3%) — leaflet shaving, 6 (28.5%) — stabilization of commissures. Preoperative coaptation height was 7±2 mm, after surgery — 13±3 mm; preoperative coaptation depth was 3±1 mm, after surgery — 8±2 mm. There was no in-hospital mortality. Aortic insufficiency was absent in 13 (54%) patients, mild regurgitation persisted in 9 (37.5%) patients, mild-to-moderate regurgitation — in 2 (8.3%) patients. Mean pressure gradient after surgery was 10.2±4.2 mm Hg, in mid-term postoperative period — 5.9±3.3 mm Hg. Six-year mortality rate was 5.3%, 6-year survival — 94.7%, 6-year freedom from redo surgery and aortic insufficiency — 100%.

CONCLUSION

Cusp repair ensuring optimal anatomy of aortic valve is essential for prevention of aortic insufficiency in long-term postoperative period.