Two different geometric orientations for aortic neorootcreation in bicuspid aortic valve repair with root reimplantation

Objective: Bicuspid aortic valve (BAV) represents 2 cusps oriented along a
spectrum of equal (180
/180
) or unequal (150
/210
) leaflet surface area
distribution along the aortic annular plane. We have taken the approach of
respecting the native geometric orientation of the repaired BAV leaflets when
creating the aortic neoroot during valve-sparing root reimplantation (VSRR)
procedures. We investigated midterm outcomes with this 2-prong approach for
VSRR in BAV syndrome.
Methods: Of 72 patients in a prospectively maintained BAV repair database, 68
met inclusion criteria: 36 patients had 180
/180
neoroot geometry, and 32 patients
had 150
/210
orientation. A multivariate ordinal logistic mixed effects
model was performed to study parameters associated with recurrent AI greater
than 2þ.
Results: Preoperative parameters were similar between 180
/180
and 150
/210

groups, except for greater incidence of AI 4þ in the latter (50.0% [n ¼ 16] vs
8.3% [n ¼ 3]; P<.001). Postoperatively, stroke, renal failure, reoperation for
bleeding, and pacemaker rates were 0 in the entire cohort. In-hospital/30-day mortality
in the entire cohort was 1.5% (n ¼ 1). Multivariate ordinal logistic mixed
effects model showed that preoperative AI greater than 3þ (odds ratio, 0.4;
P ¼ .46) and geometric orientation of the aortic neoroot (odds ratio, 3.8;
P ¼ .25) were not significantly associated with recurrence of AI greater than 2þ.
Conclusions: Respecting BAV geometry for VSRR neoroot creation yields excellent
midterm outcomes and may minimize conjoint cusp leaflet stress that may
occur in ‘‘forcing’’ a 150
/210
type I BAV into a 180
/180
neoroot. (J Thorac
Cardiovasc Surg 2020;160:47-57)

Copyright
2019 Published by Elsevier Inc. on behalf of The American Association
for Thoracic Surgery
https://doi.org/10.1016/j.jtcvs.2019.06.119