Bicuspid Aortic Valve Resuspension in Acute Type A Aortic Dissection Patients

Background. There are no data on the fate of the preserved bicuspid aortic valve (BAV) in patients with acute type A aortic dissection. We investigated surgical outcomes in BAV patients who had undergone aortic valve resuspension versus replacement for dissection type A. Methods. Among 1,500 consecutive patients operated on for acute type A dissection between 1993 and 2013 at 3 tertiary centers, 66 had BAV (68% males, median age 60 +/- 15 years). Thirteen BAV resuspension patients were compared with 53 BAV replacement patients. Median follow-up was 5.0 +/- 4.7 years. Results. The ages of both groups were similar (resuspension 62 +/- 13 vs replacement 57 +/- 15 years, p = 0.62), and both presented similar risk-factor profiles. Moderate-to-severe aortic valve regurgitation was observed in 15% of the resuspension and 45% of the replacement patients (p = 0.06). Resuspension patients required shorter cardiopulmonary bypass and cross-clamp times (153 +/- 48 vs 224 +/- 76 min, p < 0.01; 106 +/- 33 vs 172 +/- 57 min, p < 0.01, respectively). In-hospital mortality was observed in 15.4% of the resuspension and 15.1% of the replacement patients (p = 1). One replacement patient underwent a proximal reoperation. The resuspension group experienced no severe aortic regurgitation, nor any need for proximal reintervention. Overall survival was 68% +/- 13% vs 65% +/- 7% at 5 years in resuspension and replacement groups, respectively (log-rank, p = 0.97). Conclusions. The BAV resuspension in type A dissection patients showed good short-and mid-term results. It is doable with acceptable results, and full root replacement is not always necessary. (C) 2015 by The Society of Thoracic Surgeons