Aortic Valve Reconstruction with Use of Pericardial Leaflets in Adults with Bicuspid Aortic Valve Disease: Early and Midterm Outcomes

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve ( BAV) disease who underwent aortic valve reconstructive surgery ( AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients ( mean age, 49.2 +/- 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients ( 62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients ( 90.4%) underwent 3-leaflet reconstruction, and 13 ( 9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients ( 46.7%). There were no in-hospital deaths and 2 late deaths ( 1.5%); 6 patients ( 4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% +/- 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% +/- 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients ( 85.9%), mild in 16 ( 11.9%), moderate in 2 ( 1.5%), and severe in one ( 0.7%). The mean aortic valve gradient was 10.2 +/- 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 +/- 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.