Aortic Annulus Diameter Affects Durability of the Repaired Bicuspid Aortic Valve.

BACKGROUND AND AIM OF THE STUDY: An investigation was made as to whether the preoperative aortic annular diameter affects the durability of bicuspid aortic valve (BAV) repair in patients who had undergone concomitant root stabilization with subcommissural annuloplasty (SCA) compared to valve-sparing root reimplantation (VSRR).

METHODS: Among a retrospective review of 74 patients who underwent BAV repair between 2005 and 2012,42 had SCA and 32 had VSRR.

RESULTS: The preoperative annulus was similar in the two groups (29 +/- 3 mm for SCA; 30 +/- 4 mm for VSRR, p = 0.3). Postoperative aortic insufficiency (AI) grade > or = 1+ was 100%, but five-year freedom from Al grade >1+ was lower in the SCA group (62 +/- 10% versus 92 +/- 6%, p = 0.02). On univariate analysis, a preoperative annulus 28 mm was predictive of recurrent Al grade >1+ in the SCA group (odds ratio 17.1, p = 0.05), but not in the VSRR group (3.31, p = 0.1). Consequently, SCA patients were evaluated by annular diameter 28 mm (n = 26) versus < or = 27 mm (n = 16). Five-year freedom from AI grade >1+ was lower for the 28 mm SCA subgroup (52 +/- 10% versus +/-3 +/- 6%, p = 0.02). Given this difference between the SCA subgroups, Al grade >1+ in the 28 mm SCA subgroup was compared to VSRR patients with annulus 28 mm ( 28 mm VSRR subgroup, n = 23). The five-year freedom from AI grade >1+ was significantly higher in the 28 mm VSRR subgrou+/- (86 +/- 10% versus 52 +/- 10%, p = 0.02), but simila < or = Sr in the 27 27 m< or = SCA and 527 mm VSRR subgroups (93 +/- 6% versus 100%, p = 0.4).

CONCLUSION: For BAV patients with a preoperative aortic annulus 28 mm, SCA results in inferior midterm outcomes. VSRR or alternative annular stabilization techniques should be considered