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Quintessenza J. Commentary: Aortic valve reconstruction: Embrace it and master it … for your patients' sake … and your future. JTCVS Tech 2022; 11:62-63. [PMID: 35169739 PMCID: PMC8828955 DOI: 10.1016/j.xjtc.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- James Quintessenza
- Department of Cardiovascular Surgery, JHACH Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Fla
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Acharya M, Sherzad H, Tan SZCP, Bashir M, Mariscalco G. External or subcomissural annuloplasty in bicuspid aortic valve repair: Which is better? J Card Surg 2021; 37:532-534. [PMID: 34820900 DOI: 10.1111/jocs.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
Patients with a bicuspid aortic valve (BAV) are at increased risk of valvular regurgitation compared to their counterparts with a tri-leaflet aortic valve. There is now increasing emphasis to offer BAV repair to mitigate the risks of prosthesis-related complications, including thromboembolism, hemorrhage and endocarditis, as well as structural valve deterioration and future reoperation with conventional valve replacement, particularly in younger populations. Furthermore, over the preceding two decades, our greater understanding of the functional anatomy of the BAV, pathophysiological mechanisms of BAV insufficiency, and the development of a functional classification of aortic regurgitation have significantly contributed to the evolution of aortic valve reconstructive surgery. In this commentary, we discuss a recent article from the Journal of Cardiac Surgery comparing external annuloplasty and subcommissural annuloplasty as techniques for BAV repair.
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Affiliation(s)
- Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Hiwa Sherzad
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | | | - Mohamad Bashir
- Division of Vascular and Endovascular Surgery, Health Education and Improvement Wales, Nantgarw, UK
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Lansac E, Youssefi P. Rationale behind symmetrical BAV repair: time to generalize a standardized approach of bicuspid valve repair. Eur J Cardiothorac Surg 2021; 60:865-866. [PMID: 34652431 DOI: 10.1093/ejcts/ezab268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Pouya Youssefi
- Institut Mutualiste Montsouris, Paris, France.,Royal Brompton & Harefield NHS Trust, London
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Romagnoni C, Contino M, Jaworek M, Rosa R, Salurso E, Perico F, Gelpi G, Vismara R, Fiore GB, Mangini A, Antona C. Commissural repositioning in bicuspid aortic valve repair: an in vitro acute model to explore and explain different results. Eur J Cardiothorac Surg 2021; 61:647-654. [PMID: 34363669 DOI: 10.1093/ejcts/ezab359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Commissural orientation <160° is a recognized risk factor for bicuspid aortic valve repair failure. Based on this observation, repairing this subtype of aortic valve by reorienting the 2 commissures at 180° has recently been proposed. METHODS Nine porcine hearts with aortic annulus diameters of 25 mm were selected. A pathological model of a Sievers 1 bicuspid aortic valve was obtained by suturing the coaptation line between the left and right leaflets. Each heart underwent reimplantation procedures both in the native (120°) and the reoriented (180°) configuration. After the operation, each sample was tested on a pulse duplicator at rest (heart rate 60 beats per min) and with mild exercise (heart rate 90 beats per min) conditions. RESULTS No statistically significant difference was noted in mean and peak transvalvular aortic gradients between the 2 configurations at rest (18.6 ± 5 vs 17.5 ± 4 for the mean aortic gradient; 42.8 ± 12.7 vs 36.3 ± 5.8 for the peak aortic gradient) but the group with the 120°-oriented commissures had significantly higher mean transaortic gradients compared to the group with the 180°-oriented commissures at initial exercise stress conditions (30.1 ± 9.1 vs 24.9 ± 3.8; p value 0.002). CONCLUSIONS The 180° commissural reorientation of the asymmetrical bicuspid aortic valve does not improve the transvalvular aortic gradient in an acute model at rest conditions, but it could do so under stress situations. Even if it is surgically more complex and time-consuming, this approach could be a good strategy to improve long-term results, particularly in young patients.
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Affiliation(s)
- Claudia Romagnoni
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Monica Contino
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Michal Jaworek
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Rubina Rosa
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Eleonora Salurso
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesca Perico
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Guido Gelpi
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Riccardo Vismara
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Gianfranco Beniamino Fiore
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Andrea Mangini
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Carlo Antona
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Università degli Studi di Milano, Milano, Italy
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Gocoł R, Bis J, Malinowski M, Ciosek J, Hudziak D, Morkisz Ł, Jasiński M, Deja MA. Comparison of bicuspid and tricuspid aortic valve repair. Eur J Cardiothorac Surg 2021; 59:1183-1190. [PMID: 33367683 PMCID: PMC8244631 DOI: 10.1093/ejcts/ezaa462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44-56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96-37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99-9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.
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Affiliation(s)
- Radosław Gocoł
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Jarosław Bis
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
- Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
| | - Marcin Malinowski
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
- Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
| | - Joanna Ciosek
- 3rd Department of Cardiology, Upper-Silesian Heart Center, Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Łukasz Morkisz
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Marek Jasiński
- Department of Cardiac Surgery, Wrocław Medical University, Wrocław, Poland
| | - Marek A Deja
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
- Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
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