Study Population
From January 1999 through December 2017, 142 consecutive patients underwent repair of a regurgitant BAV with or without root or ascending aorta enlargement at our hospital. Patients with isolated BAV repair (n=94; Group 1) and patients with valve-sparing aortic root replacement plus BAV repair (aortic valve reimplantation –
David procedure; n=48; Group 2) were included in this analysis.
Before surgery, all patients were routinely examined by transthoracic echocardiography (TTE), coronary angiography and/or cardiac computed tomography (CT). An intraoperative transoesophageal echocardiography (TEE) was performed in all patients to evaluate valve function pre- and post-cardiopulmonary bypass to facilitate the surgical procedure and to assess the immediate result of AV surgery as well as the left ventricular function during weaning from cardio-pulmonary bypass and adequacy of de-airing of cardiac chambers. The echocardiographic classification of residual/recurrent AV regurgitation was as follows: grade 0 – none/trace; grade 1 – trivial; grade 2 – mild; grade 3 – moderate; and grade 4 – severe. Every patient received a TTE at discharge.
All patients were followed-up prospectively and systematically by means of annually mailed questionnaires or phone interviews and/or by clinical assessment and TTE in our outpatient clinic. For patients not seen personally we retrieved clinical assessment and echocardiography reports from the attending cardiologist.
The mean age of Group 1 was 45±14 years (14% female) and 49±13 years (10% female) in Group 2, respectively (p=0.05). The median age of Group 1 was 43 years (range 18-70), 48 years (range 24-71) in Group 2, respectively. Most of the patients had aortic regurgitation (AR) ≥grade 2 (83% in Group 1 and 73% in Group 2; p=0.2). 17% of Group 1 patients had AR=1° and aneurysm of the ascending aorta. In Group 2 the aortic root and ascending aorta was enlarged with mean diameter of 4.5±0.7 cm and 5.0±0.9 cm), respectively. The patient’s preoperative characteristics are summarized in Table 1.
Clinical follow-up was complete in 98% for both groups. Mean follow-up was 6.6±4 years (Group 1) and 4.7±4 years (Group 2). Median follow-up time was 5.9 years (range 0.5-15) in Group 1 and 3 years (range 0.5-16) in Group 2, respectively.
This study was approved by the local ethics committee (reference number: 422/12) and informed consent was obtained from each patient.