Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair

Objectives: To assess root replacement and annular stabilization in bicuspid aortic valve repair, we compared results of reimplantation technique versus subcommissural annuloplasty or no annuloplasty. Methods: Between 1995 and 2010, 161 consecutive patients underwent bicuspid aortic valve repair. Patients undergoing subcommissural annuloplasty or no annuloplasty (group 1, n = 87) had larger root dimensions and less aortic insufficiency than did patients undergoing reimplantation technique (group 2, n = 74). We matched groups 1 to 1 on basis of those criteria. After matching (n = 106, n = 53 per group), root dimensions (41.5 +/- 5 vs 40 +/- 4 mm; P = .2) and degree of insufficiency (2.6 +/- 1.2 vs 2.7 +/- 1; P = .6) were similar between groups. Results: Techniques of cusp repair were similar between groups. Group 2 had smaller preoperative left ventricular size (P - .02), fewer concomitant procedures (P - .02), and shorter follow-up (41 +/- 30 vs 63 +/- 40 months; P = .003). There were no in-hospital deaths. At discharge, residual aortic insufficiency was similar between groups, but peak gradient greater than 25 mm Hg was more frequent in group 1 (13% vs 30%; P = .04). At 6 years, overall survival was 98% +/- 3% in both groups. Freedoms from reoperation and aortic insufficiency greater than 2+ were significantly better in group 2 (100% vs 90% +/- 8%; P = .03; 100% vs 77% +/- 14%; P = .002). Conclusions: In bicuspid aortic valve repair, root replacement with the reimplantation technique stabilizes the ventriculoaortic junction, improves valve mobility (low gradient), and is associated with improved outcomes. (J Thorac Cardiovasc Surg 2011;142:1430-8)