Repair of the Common Type of Bicuspid Aortic Valve with Insufficiency

Presented at the STS 2011 Annual Meeting

Surgical techniques for repair of insufficient bicuspid aortic valves are now quite reproducible. Outcome analyses have shown low late valve-related complication and failure rates. This video illustrates bicuspid repair techniques emphasizing inter-patient variability and operative decision-making.

Videos and operative echocardiograms from 4 patients are shown to illustrate the anatomic spectrum of bicuspid valves with fusion of left/right coronary cusps. Anatomic variability is categorized into 3 areas: 1) annular size, 2) degree and type of leaflet prolapse, and 3) magnitude of fused cusp clefting. The defects are corrected by varying degrees of 1) commissural annuloplasty, 2) leaflet plication to correct prolapse, and 3) cleft closure.

Each of the 4 patients had variable application of repair techniques, depending on the individual anatomy. All obtained excellent anatomic and hemodynamic results, with negligible residual leak, good leaflet effective height (> 8 mm), and adequate leaflet coaptation area. Individual decision-making is discussed.

We conclude that common type of bicuspid aortic valve with insufficiency can be repaired reproducibly with good anatomic and clinical results. Repair techniques should be individualized to each patient’s anatomy. Surgical reconstruction now might be considered the primary procedure for this disorder.

Video Copyright 2011, used with permission from The Society of Thoracic Surgeons. All rights reserved.

Figures from the following article appear in the video by permission of Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery who holds the copyright:

1. Diana Aicher et al. Aortic valve repair leads to a low incidence of valve-related complications Eur J Cardiothorac Surg (2010) 37(1): 127-132, Figs. 1-3

Figures from the following articles appear in this video and are used by permission of Elsevier who holds the copyright:

1. Journal of Thoracic & Cardiovascular Surgery, vol 132, pp 436-438, Schäfers et al., "A new approach to the assessment of aortic cusp geometry", Figure 1
2. Journal of Thoracic & Cardiovascular Surgery, vol 134, pp 1533-1539, Aicher et al., "Cusp repair in aortic valve reconstruction: Does the technique affect stability?", Figure 1
3. Operative Techniques in  Thoracic & Cardiovascular Surgery, vol 12, pp 2-13, Schäfers "Reconstruction of the bicuspid aortic valve", Figure 5