Comparison of Bicuspid and Tricuspid Aortic Valve Cusp Reconstruction: Single-Center Experience

Background: The aim of this study was to evaluate the outcomes of isolated cusp repair in bicuspid aortic valve (BAV) compared with tricuspid aortic valves (TAV).

Method: From 2002 to 2020, a total of 103 elective AV cusp reconstruction procedures were performed, including 57 patients (55%) with BAV-, and 46 patients (45%) with TAV-morphology. We assessed freedom from reoperation, survival rates, the rate of AV-regurgitation recurrence, and 30-day and late mortality. Risk factors for reoperation were identified.

Results: The 30-day mortality was 0.8% (1/103) Overall, 5- and 10-year survival rates in the BAV versus TA -group were 95% versus 97%; p-value 0.30, and 92% versus 93%; p-value 0.64, respectively. Freedom from AV reoperation at 5 and 10 years in the BAV versus TAV-group were 98 vs. 96%; p-value, and 94 vs. 91%; p-value 0.38, respectively. At last FU echocardiography, 13 patients (25%) showed AR grade 0, 40 patients (75%) AR grade I, and no AR ≥ II in the BAV-group, compared with 9 patients (21%) showed AR grade 0, 33 patients (79%) AR grade I, and no AR ≥ II in the TAV group, p-value 0.43. Mean transvalvular gradient at last FU was 16 ± 6 mm Hg in the BAV-group, and 13 ± 5 mm Hg in the TAV-group, p-value of 0.46. Reoperation was predicted by the use of decellularized extracellular matrix patch hazard ratio 7.34 (1.72–26.21); p-value 0.003, and AV annulus diameter ≥25 mm hazard ratio 2.98 (0.81–8.93); p-value of 0.063.

Conclusion: BAV isolated cusp reconstruction is as durable as TAV cusp reconstruction. AV annulus diameter ≥25 mm and the use of decellularized extracellular matrix patch adversely impact long-term durability of AV cusp reconstruction.

Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2022