Isolated bicuspid aortic valve repair: Experience over two decades

Abstract

BackgroundRepair of the bicuspid aortic valve has evolved in the past 20 years. The aim of this study was to review two decades of experience and analyze the long-term stability of BAV repair. MethodsBetween 10/1998 and 12/2020, 547 adult patients (92% male; 41.9±13.4 years) underwent a bicuspid aortic valve repair with (n=400) or without (n=147) annuloplasty. Sinus plication was performed in 175 instances (32%). Mean follow-up of 73.3±56 months (median 59.9 months); it was 92% complete. Survival and freedom from reoperation were calculated. ResultsSurvival at 20 years was 93.2%±2.7, freedom from reoperation at 20 years was 83.7±2.9. Freedom from AI≥II was 77.7%±3.4 at 15 years. By logistic regression analysis, the use of pericardial patches for cusp repair (p=0.019; OR 2.6), the use of subcommissural plication (p<.0001; OR 7.3), and the lack of annuloplasty (p<.0001; OR 17) were independent predictors for reoperation. ConclusionIsolated bicuspid aortic valve repair is associated with excellent survival, and the majority of BAV repairs will remain stable over more than 10 years. The use of an annuloplasty improves repair durability and patient survival. Cusp calcification and cusp repair using a pericardial patch are predictors for early valve failure.