Figure - available from: Journal of Cardiac Surgery
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Aortic root Z values of patients with bicuspid aortic valve before the Ross procedure (A) and at follow‐up (B). R/L, right and left leaflets fusion; R/N, right and noncoronary leaflets fusion
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Background:
In addition to being associated with aortopathy, a bicuspid aortic valve (BAV) has been posed to be a risk factor for the dilation of the pulmonary autograft in the aortic position. The aim of this study is to assess the association between the subtype of native aortic valve leaflet fusion (right and noncoronary leaflets [R/N] vs right...
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The Ross procedure has long been seen as an optimal operation for a select few. The detractors of it highlight the issue of an additional harvesting of the pulmonary artery, subjecting the native PA to systemic pressures and the need for reintervention as reasons to avoid it. However, the PA is a living tissue and capable of adapting and remodeling...
Background:
Bicuspid aortic valve (BAV) disease is considered the most common congenital heart disease and the main etiology of aortic valve stenosis (AS) in young adults. Although transcatheter aortic valve replacement (TAVR) is routinely used in high- and intermediate-risk patients with AS, BAV patients with AS were excluded from all pivotal tri...
Congenital heart disease (CHD) may cause a significant comorbidity in patients with Turner syndrome. The commonly reported CHD in these patients includes bicuspid aortic valve and coarctation of the aorta. Left ventricular noncompaction (LVNC) is a rare form of cardiomyopathy that has been reported in literature only three times in adult patients w...
Ross procedure is a valid option for the treatment of aortic valve disease in children and young adults. However, the benefits of this operation are limited by the risk of reoperation for autograft degeneration. A limited number of clinical reports regarding valve repair after Ross procedure are available. Among those, repair of a unicuspid autogra...
Citations
... 6 Currently, there is limited information regarding whether the type of leaflet morphology in BAV is associated with abnormalities of valve function and the aortic size in a young adult population. 5,7,8 The aim of this study was to analyze the impact of leaflet fusion pattern on aortopathy severity and the differences in aortic root diameter in patients ...
... 14,15 The relative distribution of morphologically distinct cusp fusion patterns in BAV (ie, R/L and R/N) observed in this study is similar to those demonstrated in earlier reports. 8,16 Previous series have described that 70% to 75% of patients with BAV have fused R/L coronary cusps, whereas R/N cusp fusion is less prominent and found in only 20% of patients with BAV. The series in this study revealed the prevalence of R/L fusion to be very similar (R/L, 75% vs R/N, 25%). ...
Background:
Patients with bicuspid aortic valves (BAVs) tend to develop dilation of the ascending aorta. The aim of this study was to analyze the impact of leaflet fusion pattern on aortic root diameter and outcomes in patients undergoing surgery for BAV vs tricuspid aortic valve (TAV) disease.
Methods:
This is a retrospective review of 90 patients with aortic valve disease (mean [SD] age, 51.5 [8.2] years) who underwent aortic valve replacement for BAV (n = 60) and TAV (n = 30). Fusion of right-left (R/L) coronary cusps was identified in 45 patients, whereas the remaining 15 patients had right-noncoronary (R/N) cusp fusion. Aortic diameter was measured at 4 levels, and Z values were computed.
Results:
There were no significant differences between the BAV and TAV groups for age, weight, aortic insufficiency grade, or size of implanted prostheses. However, a higher preoperative peak gradient at the aortic valve was significantly associated with R/L fusion (P = .02). Preoperative Z values of ascending aorta and sinotubular junction diameter were significantly higher in patients with R/N fusion than with the R/L (P < .001 and P = .04, respectively) and TAV (P < .001 and P < .05, respectively) subgroups. During the follow-up period (mean [SD], 2.7 [1.8] years), 3 patients underwent a redo procedure. At the last follow-up, the sizes of ascending aorta were similar among all 3 patient groups.
Conclusion:
This study suggests that preoperative dilation of the ascending aorta is more common in patients with R/N fusion than in patients with R/L and TAV but is not significantly different between all groups in the early follow-up period. R/L fusion was associated with an increased risk of preoperative presence of aortic stenosis.
The treatment of aortic stenosis has evolved in recent years with the introduction of transcatheter aortic valve replacement (TAVR) as a complementary strategy to surgical aortic valve replacement (SAVR). The majority of clinical trials to date have included only tricuspid aortic stenosis and excluded bicuspid aortic valves (BAVs). BAVs are associated with unique challenges related to their anatomy, clinical presentation, and association with aortopathy. BAV has a spectrum of phenotypes and the classification is still evolving. There have been no definitive clinical guidelines on triaging BAV patients towards TAVR or SAVR. Given that TAVR is moving from high-risk to low-risk patients and becoming more widely used in the treatment of BAV, there are many factors that must be considered. The aim of this article is to review the literature and present considerations for heart teams to discuss in order to offer patients the best lifetime management strategy for BAV stenosis.
