The Journal of thoracic and cardiovascular surgery, 17 3 2025, Pages S0022-5223(25)00120-5 Valve sparing aortic root replacement in bicuspid aortic valves, the reimplantation technique: A multicenter study. Arabkhani B, Boodhwani M, De Paulis R, Chen EP, Koolbergen D, Mastrobuoni S, Aphram G, Salica A, Jahanyar J, El Khoury G, de Kerchove L
Reported outcome in patients with bicuspid aortic valves(BAV) undergoing valve-sparing root replacement(VSRR) is scarce. This study aims to evaluate outcomes in patients with BAV, utilizing the reimplantation (David)technique. Consecutive adult patients, with BAV, aortic root aneurysm and/or valve insufficiency(AI) undergoing VSRR(reimplantation)), were included, from 5 centers experienced in reimplantation-procedure. Patients were subcategorized into 2 groups with different primary indications for operation: 1) aneurysm, and 2) isolated AI. acute aortic dissection, endocarditis, and valvular-stenosis. 498 patients were included. Mean age 45.4(± 11.8); median follow-up was 5.4 years(IQR 2.3-8.7 years). Group 1: Aneurysm(N=144) and group 2: AI (N=354). There was one in-hospital death. Survival(overall) was 93.4% (95% CI 92-97%) at 10 years, no difference between groups(p=0.93). Freedom from reintervention at 1 year was 99.1% (95% CI 99-100%), at 5 years 95.4% (95% CI 93-97%), and at 10 years 89.2% (95% CI 86-93%); for patients with aneurysm 100% at 1 year and 95.4% (95% CI 92-98%) at 10 years; and for AI 98.9% (95% CI 98-99%) at 1 year and 86.4% (95% CI 83-91%) at 10 years. Cusp fenestrations(P=0.01), prolapse(P=0.04), and isolated AI(0.03) were associated with higher hazard of reintervention. This multicenter study shows excellent results after VSRR, reimplantation procedure, in patients with BAV and aortic aneurysm and/or valve insufficiency. Isolated AI and cusp abnormalities are associated with higher reintervention rate and may reflect more advanced leaflet disease. The reimplantation technique, when performed in expert centers, appears to be an excellent treatment strategy in BAV.
