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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2003 February;44(1):19-23

language: English

Midterm results of conservative repair of the incompetent bicuspid aortic valve

Kin H., Izumoto H., Nakajima T., Kawase T., Kamata J., Ishihara K., Kawazoe K.

Depart­ment of Car­di­o­vas­cular Sur­gery Iwate Med­ical Uni­ver­sity Memo­rial ­Heart ­Center, Iwate, ­Japan


Aim. ­Repair of the ­bicuspid ­aortic ­valve is not gen­er­ally con­sid­ered the treat­ment of ­choice. Our suc­cess ­with ­this pro­ce­dure ­leads us to ­report our imme­diate and mid-­term ­results.
­Methods. ­From ­August 1993 to ­December 2000, 19 ­patients ­with ­aortic regur­gi­ta­tion due to con­gen­ital ­aortic ­valve under­went ­aortic ­valve ­repair (17 men and 2 ­women ­with a ­mean age of 42±17 ­years; ­range, 16 to 70 ­years). The ­mean pre­op­er­a­tive ­aortic regur­gi­ta­tion ­grade was 3.1±0.8 on a ­scale of 1 to 4. ­Mean pre­op­er­a­tive New ­York ­Heart Asso­ci­a­tion func­tional ­class was 1.9±0.8. Four­teen ­patients had ­pure ­aortic regur­gi­ta­tion, 2 ­also had infec­tious endo­car­ditis, 1 had ­angina pec­toris, and 2 had an ­ascending ­aortic aneu­rysm.
­Results. ­There was 1 hos­pital ­death (5.2%), and 1 ­patient ­required re-op­er­a­tion due to recur­rent infec­tious endo­car­ditis. ­Mean ­aortic regur­gi­ta­tion ­grade at dis­charge was 1.1±0.9, and func­tional ­class was 1.1±0.2. All ­patients ­were fol­lowed for a ­mean dura­tion of 40±23 ­months (range, 0.5 to 84 ­months). ­There was 1 ­late ­death, and two ­patients ­required ­aortic ­valve replace­ment. The 5-­year sur­vival ­rate was 90±7%. The 1- and 5-­year re-op­er­a­tion-­free ­rates ­were 87±12% and 76±23%.
Con­clu­sion. ­Bicuspid ­aortic ­valve ­repair is a ­safe pro­ce­dure ­with ­good ­early post­op­er­a­tive ­results. How­ever mid­term ­results are not sat­is­fac­tory. Re-op­er­a­tion is a prom­ising alter­na­tive and ­progress ­aortic regur­gi­ta­tion ­were com­pli­ca­tions. ­Bicuspid ­aortic ­valve ­repair to ­valve replace­ment ­that ­requires addi­tional ­study to indi­vid­u­alize treat­ment.

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