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Repair of Regurgitant Biscuspid Aortic Valves according to Functional Classification of Aortic Insufficiency: Long Terms Results
Khalil Fattouch1, Giuseppe Bianco1, Giuseppe Nasso2, Giacomo Murana3, Sebastiano Castrovinci3, Massimo Salardino1, Emanuela Clara Bertolino4, Giuseppa Caccamo4, Giuseppe Speziale2.
1Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Palermo, Italy, 2Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Bari, Italy, 3Department of Cardiovascular Surgery, University of Bologna, Bologna, Italy, 4Department of Cardiovascular Disease, University of Palermo, Palermo, Italy.

Repair of regurgitant biscuspid aortic valves according to functional classification of aortic insufficiency: long terms results
K. Fattouch, G.Bianco, G.Nasso, G. Murana, S. Castrovinci, M. Salardino, E.C. Bertolino, G. Caccamo, G. Speziale.
Objective: Bicuspid aortic valve (BAV) is frequently associated with aortic insufficiency (AI) due to cusps disease or aortic root dilatation. Starting from the functional classification of AI, we used a reconstructive systematic approach.
Methods: From February 2003 to January 2012, 92 consecutive patients (mean age 55±15 years; 78% male) underwent aortic valve repair (AVR) for regurgitant BAV with or without aortic root surgery. We identified Type I lesions in 23.9% of patients, Type II in 61.9% and Type III in 14.2%. Cusp pathology was treated with central plication (n=35), free edge reinforcement (n=31), triangular resection (n=14), pericardial patch (n=10) and our approach “the chordae technique” (n=30). Root dilatation was corrected with subcommissural plasty (n= 25), supracommissural aortic replacement (n=29), or valve reimplantation (n=47). Mean follow-up was 50±18 months.
Results: The severity of aortic insufficiency, as assessed by Doppler echocardiography (graded from 0 to 4) preoperatively and at late follow-up, was 3.5 ± 0.6, and 0.7 ± 0.9, respectively, and freedom from recurrence of AI ≥ grade II of 92.5%. There have been no operative and postoperative deaths. Freedom from reoperation was significantly different between Type I+II and type III (p<0.01), and between “the chordae technique” and plication compared to free edge reinforcement (p<0.01). Significant difference was found between AVR and valve reimplantation compared with isolated AVR (p=0.02). Aortic root diameter between 40 to 45 mm in patients underwent AVR alone is more likely associated with reintervention.
Conclusions: Type I and II BAV can be ease reproducibly repaired and is associated with long term low incidence of recurrent insufficiency. Valve reimplantation had better outcomes compared with isolated AVR. Aortic size larger than 40 mm should be considered triggers for concurrent aortic root repair.


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