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Bicuspid-aortic-valve repair shows long-term efficacy

JAMA Cardiology
Reuters Health - 23/09/2020 - A large proportion of bicuspid aortic valve (BAV) repairs using a modified anatomy-based technique remain stable and lead to excellent long-term survival, according to researchers in Germany.

BAV, the most common congenital cardiac anomaly, is characterized by a variable degree of fusion between two cusps and the presence of a nonfused cusp that is almost always larger than the two components of the fused cusp.

A number of BAV patients will need treatment for either aortic regurgitation or ascending aortic aneurysm, Dr. Ulrich Schneider of Saarland University Medical Center, Homburg, and colleagues note in JAMA Cardiology. Reconstruction of the regurgitant BAV has been successfully performed for more than two decades, they add, but a considerable proportion of the repaired valves failed within five years.

To determine how the technique has since evolved, the researchers examined data on a case series of more than 1,000 patients (mean age, 46 years) who underwent the procedure with or without concomitant tubular aortic replacement between 1995 and 2019. Mean follow-up was 56 months, with a maximum of more than 22 years. Most patients (89.8%) were men.

The survival rate at 15 years was 82.1% and the cumulative incidence of reoperation during that period was 30.7%. However, in 2009 systematic modifications in technique using a repair strategy that was adapted to the anatomic characteristics of the valve were introduced.

At 10 years, in the 727 patients who were operated on using this approach, the incidence of reoperation was 8.8%, significantly less than the 24.6% seen in patients before the anatomy-based repair strategy was employed. Ten-year survival was also significantly higher (98.7% vs. 87.6%).

Risk factors associated with valve failure were cusp calcification, asymmetric commissural orientation, and in particular the need for partial cusp replacement.

"Bicuspid aortic valve repair with or without concomitant aortic replacement is associated with long-term stability if all pathologic components of the aortic valve and root, including commissural orientation, are addressed," the researchers write.

Dr. Schneider did not respond to requests for comments.

By Reuters Staff

SOURCE: https://bit.ly/3hZZwWQ JAMA Cardiology, online September 16, 2020.

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