Reconstruction of the Bicuspid Aortic Valve

Abstract

Abicuspid aortic valve (BAV) occurs in 2% of the population and is a common reason for significant aortic regurgitation, particularly in the third and fourth decades of life.1 In these young patients, the choice of valve substitute is difficult. With a mechanical valve, the linearized risk of thromboembolic complications and anticoagulation-related hemorrhage is low,2 but the cumulative risk may be substantial due to a long life expectancy. Many young individuals do not wish a coumadin-based anticoagulation for lifestyle reasons. A biologic prosthesis, on the other hand, is associated with suboptimal durability in younger patients.3 Thus, for patients with a regurgitant bicuspid aortic valve, repair appears an attractive alternative to replacement. Bicuspid aortic valve anatomy is also associated with aortic dilation in more than 50% of individuals.4 Aortic dilation may induce or aggravate aortic valve regurgitation, and there is increasing evidence that a diameter of more than 4.5 cm may be associated with impaired long-term prognosis.5 Elimination of a dilated ascending aorta may also serve the purpose of stabilizing a valve repair procedure.6 Thus, any reconstructive procedure on a bicuspid aortic valve should address aortic pathology, if present. We have developed a differentiated approach to these procedures that has worked well in more than 180 patients operated over an 11-year period. Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany. Address reprint requests to H.-J. Schafers, MD, Dept. of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, 66421 Homburg/ Saar, Germany. E-mail: h-j.schaefers@uniklinikum-saarland.de