Mid and Long-term Valve Stability Following Valve Sparing Aortic Root Replacement: Outcomes in Bicuspid Aortic Valve Compared with Tricuspid Aortic Valve

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Résumé

Objective: Early and long-term valve stability following VSRR, were comparatively analyzed between tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV). Methods: From January 2003 to February 2018, 140 consecutive patients (37 BAV and 103 TAV) underwent VSRR surgery. Mean age was 48.5 ± 11.6 years in BAV and 59.1 ± 11.8 years in TAV. All BAV presented New York Heart Association functional class I or II versus 88% of TAV. BAV presented with aortic regurgitation (AR) grade III or IV in 38% versus 58% of TAV. Mean left ventricular ejection fraction (LVEF) was 61.6% ± 7.8 for BAV versus 61.0% ± 9.0 for TAV. Leaflet repair was performed in all BAV versus 73% of TAV. Patients were yearly followed by referent cardiologists. Follow-up was 96% complete with an average mean duration of 5.02 years (range: 6 months - 14.3 years). Results: In-hospital mortality was nil in BAV and 2% in TAV. On long-term, there were no clinical and echocardiographic differences in the two groups: all BAV and TAV presented NYHA class 1 or 2, mean LVEF was 65% in BAV and 60.3% in TAV; no patient in either group presented AR > grade 2 and mean gradient median was 9 and 4 mm Hg, respectively, for BAV and TAV. There were 14 late deaths (10%) including 2 BAV (stroke 1, drowning 1) and 12 TAV (cardiac 6, other 6). Four TAVs were re-operated: Bentall 2, Transcatheter Aortic Valve Implantation 1 and mitral valve repair 1. Late major complications were reported in 4 patients: (BAV: stroke 1. TAV: stroke 1, pulmonary 2). Conclusion: VSRR ensures long-term stability of aortic valve function independently to its morphology. In BAV associated with aortic root aneurysm, leaflet repair does not increase the valve-related events.

Mots-clés

Bicuspid aortic valve, Medicine, Cardiology, Internal medicine, Aortic valve, Ejection fraction, Regurgitation (circulation), Bicuspid valve, Heart failure