Re-Repair of the Bicuspid Aortic Valve

Abstract

Methods: Between 2004 and 2015, 32 patients (mean age 41 ±13 years, 96.6% male) underwent BAV re-repair for recurrent aortic regurgitation. In 15 patients (46.9%), valve failure was caused by suboptimal aortic root or valve configuration. At reoperation, it was corrected by modification of root dimensions (i. e. aortic replacement/annuloplasty) or valve morphology. Other causes for reoperation were pericardial patch failure (n=6, 18.8%), cusp restriction (n=3, 9.4%), fenestrations (n=2, 6.3%), cusp calcification (n=2, 6.3%), aortic dissection (n=1, 3.1%), recurrent prolapse (n=1, 3.1%), endocarditis (n=1, 3.1%) and unrecognized unicuspid valve morphology (n=1, 3.1%). Results: No patient died in hospital. Survival at 5 and 10 years was 96% and 84% respectively. During follow-up, 15 patients (46.9%) required repeat aortic valve reintervention. Freedom from reoperation at 5 and 10 years was 59% and 45%. Best repair durability was observed after root or valve modification with 5 and 10-year freedom from reoperation of 74%. After re-repair for patch failure, freedom from reoperation was 33% at 5 and 0% at 10 years (p=0.015). All BAVs re-repaired for cusp calcification or fenestrations and due to unrecognized unicuspid morphology failed during follow-up. After re-repair for cusp restriction, only one (33%) patient showed stable valve function over time. All other patients (n=3) required no further BAV intervention.