Eligibility assessment for aortic valve repair in adults congenital patients

Abstract

Aortic valve (AV) pathology in adult congenital heart disease (ACHD) patients has its own etiologies: bicuspid aortic valve (BAV), conotruncal anomalies, Laubry-Pezzi syndrome, subvalvular aortic membrane, genetic disorders or postoperative lesions (Ross procedure or previous AV repair). Following the example of mitral plasty in the 1980s, surgical techniques for AV repair have been standardized since the 2000s and show very good results in selected patients, allowing a substantial reduction in the risk of prosthesis-related complications. To present an accurate and reproducible transthoracic and transesophageal echo protocol analysing aorta phenotypes and AV and predict the immediate success of AV repair in ACHD patients. The study involved a retrospective analysis of all the ACHD patients operated between January 2018 and May 2022 for AV surgery at the Georges Pompidou European Hospital in Paris. Clinical characteristics, type of ACHD, severity and type of valve involvement (insufficiency, stenosis, or dilatation of the aortic root) were collected. Preoperative and postoperative transthoracic and transesophageal echography were performed using a unique protocol with a 3D approach. Preoperatively, the AV dysfunction, its lesion at the origin and its etiology were defined. Measurements of aortic annulus, effective heights, geometric heights, commissural angle if BAV were made, and the presence of fenestrations, calcifications were noted. In case of AV repair, all measurements were repeated postoperatively. The surgical techniques of aortic plasty were noted. Sixty-three patients were analyzed, 46% of whom were referred for AV repair. Fifty percent of them had BAV, 30% of them were redux of AV repair (20%) or Ross procedure (10%), 20% had conotruncal anomalies. Aortic plasty was performed in 33% of patients, including external ring annuloplasty in case of AV regurgitation with an annulus diameter ≥ 25 mm. We analyzed which patients have the best chance to be reparable. ACHD patients are challenging patients for AV repair. A standardized echo protocol helps to predict the reparability, in order to know if the cardiologist should address his patient in expert surgeons’ hands.