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Repair of the bicuspid aortic valve: A viable alternative to replacement
with a bioprosthesis
Original Link:
http://jtcs.ctsnetjournals.org/cgi/content/abstract/139/6/1395
Elena Ashikhmina, MD, PhDa, Thoralf M.
Sundt, III, MDa, Joseph A. Dearani, MDa,
Heidi M. Connolly, MDb, Zhuo Li, MSc,
Hartzell V. Schaff, MDa,*
a Division of Cardiovascular Surgery, Mayo Clinic,
Rochester, Minn
b Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
c Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, Minn
Received for publication July 2, 2009; revisions received
December 15, 2009; accepted for publication February 13, 2010.
Objective: We sought to compare the safety and durability of
bicuspid aortic valve repair versus replacement with a bioprosthesis.
Methods: We reviewed medical records of patients aged 18 years or older
undergoing bicuspid aortic valve repair for aortic regurgitation
from 1984 through 2007. We analyzed early outcomes and predictors
of aortic valve replacement after initial repair. Patients with
repair were compared with an age- and sex-matched cohort who had
replacement with a bioprosthesis. Overall survival and survival free
from reoperations were compared between groups.
Results: The mean follow-up period for 108 consecutive patients with
repair was 5.1 (standard deviation, 4.1) years. The initially
repaired valve was subsequently replaced in 19 (18%) patients. No
bicuspid aortic valve repair technique or morphologic characteristic
included in univariate risk factor analysis was associated with
increased probability of replacement after initial repair. The 5- and
10-year survival rates after repair were 96% and 87%, respectively.
Freedom from valve replacement was 96%, 89%, and 49% at 1, 5, and 10
years after repair, respectively. A separate analysis of 81 matched
patients with repair or receipt of an aortic valve bioprosthesis
showed no significant difference in 10-year survival (72% vs 79%,
P = .13) or freedom from reoperation between groups (90% vs 98%
and 72% vs 64% in 5 and 10 years, respectively; P < .12).
Conclusions: Bicuspid aortic valve repair is a viable alternative to
replacement with a bioprosthesis because durability and safety are
similar between both surgical management methods for aortic
regurgitation. After initial repair, approximately half of the
patients require aortic valve replacement within 10 years.
Abbreviations and Acronyms AR = aortic
regurgitation; AV = aortic valve; AVR = aortic valve replacement; BAV
= bicuspid aortic valve; SD = standard deviation
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