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. 2021 Jun 14;59(6):1183-1190.
doi: 10.1093/ejcts/ezaa462.

Comparison of bicuspid and tricuspid aortic valve repair

Radosław Gocoł  1 , Jarosław Bis  1   2 , Marcin Malinowski  1   2 , Joanna Ciosek  3 , Damian Hudziak  1 , Łukasz Morkisz  1 , Marek Jasiński  4 , Marek A Deja  1   2
Affiliations

Comparison of bicuspid and tricuspid aortic valve repair

Radosław Gocoł et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair.

Methods: We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified.

Results: From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44-56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96-37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99-9.58); P = 0.053].

Conclusions: BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

Keywords: Aortic valve repair; Bicuspid aortic valve; Tricuspid aortic valve.

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Figures

Figure 1:
Figure 1:
Kaplan–Meier curves. (A) Survival of patients with bicuspid and tricuspid aortic valve. (B) Freedom from reoperation in patients with bicuspid and tricuspid aortic valve. Kaplan–Meier curves with 95% confidence interval. Estimated 5-year survival/freedom from reoperation is given with standard error. P from log-rank (Mantel–Cox) test.
Figure 2:
Figure 2:
Influence of aortic annulus diameter on hazard of reoperation. Kaplan–Meier curves with 95% confidence interval. Estimated 5-year freedom from reoperation is given with standard error. P from log-rank (Mantel–Cox) test.
Figure 3:
Figure 3:
Rate of aortic valve regurgitation.
None
See this image and copyright information in PMC

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