Suture Annuloplasty Significantly Improves the Durability of Bicuspid Aortic Valve Repair

Abstract

Background: Isolated repair of the regurgitant bicuspid aortic valve (BAV) has yielded suboptimal durability, with annular dilatation being important risk factor for recurrent aortic regurgitation. We hypothesized that adding a suture annuloplasty (SA) should lead to improved repair stability.

Methods: Between July 1999 and September 2014, 268 patients (mean age, 41 ± 13 years, 249 male) underwent isolated BAV repair. From January 2009 to September 2014, 164 consecutive patients (study group) underwent SA using either braided polyester (n = 37) or expanded polytetrafluorethylene (PTFE) (n = 127). Patients who underwent surgery prior to January 2009 served as controls (n = 104). All patients were followed (98.9% complete, 1 week to 181 months).

Results: Annular size was larger in the study group (p < 0.001) and age was lower (p < 0.001). There were no differences between the groups regarding other clinical data. Hospital mortality was 0.7% (n = 2), 10-year survival was 94.2%. Thirty-six patients required valve-related reoperations (8 days to 94 months postoperatively; controls = 32, study = 4). Complications related to SA (ventricular septal defect, interference with coronary artery) occurred in 6 (3.7%) patients, in 4 (10.8%) patients with polyester SA and in 2 (1.6%) patients with PTFE. In the control group freedom from reoperation at 5 and 10 years was 73.2% and 63.7%, respectively. With SA, 5-year stability was significantly improved to 92.6% (p = 0.0006); it was 96.7% for PTFE versus 83.5% for polyester SA (p = 0.0132).

Conclusions: Annular dilatation is a risk factor for failure after repair of regurgitant BAV. Its elimination through the use of SA significantly improves repair stability. With PTFE as material for SA optimal repair stability and minimal local complications are achieved.