Aortic Annulus Diameter Affects Durability of the Repaired Bicuspid Aortic Valve

Background and aim of the study: An investigation was made as to whether the preoperative aortic annular diameter affects the durability of bicuspid aortic valve (BAV) repair in patients who had undergone concomitant root stabilization with subcommissural annuloplasty (SCA) compared to valve-sparing root reimplantation (VSRR).

Methods: Among a retrospective review of 74 patients who underwent BAV repair between 2005 and 2012, 42 had SCA and 32 had VSRR.

Results: The preoperative annulus was similar in the two groups (29 ± 3 mm for SCA; 30 ± 4 mm for VSRR, p = 0.3). Postoperative aortic insufficiency (AI) grade ≥1+ was 100%, but five-year freedom from AI grade >1+ was lower in the SCA group (62 ± 10% versus 92 ± 6%, p = 0.02). On univariate analysis, a preoperative annulus ≥28 mm was predictive of recurrent AI grade >1+ in the SCA group (odds ratio 17.1, p = 0.05), but not in the VSRR

group (3.31, p = 0.1). Consequently, SCA patients were evaluated by annular diameter ≥28 mm (n = 26) versus ≤27 mm (n = 16). Five-year freedom from AI grade >1+ was lower for the ≥28 mm SCA subgroup (52 ± 10% versus 93 ± 6%, p = 0.02). Given this difference between the SCA subgroups, AI grade >1+ in the ≥28 mm SCA subgroup was compared to VSRR patients with annulus ≥28 mm (≥28 mm VSRR subgroup, n = 23). The five-year freedom from AI grade >1+ was significantly higher in the ≥28 mm VSRR subgroup (86 ± 10% versus 52 ± 10%, p = 0.02), but similar in the ≤27 mm SCA and ≤27 mm VSRR subgroups (93 ± 6% versus 100%, p = 0.4).

Conclusion: For BAV patients with a preoperative aortic annulus ≥28 mm, SCA results in inferior midterm outcomes. VSRR or alternative annular stabilization techniques should be considered in these patients, irrespective of the sinus segment diameter.

The Journal of Heart Valve Disease 2015;24:412-419