Impact of Cusp Repair on Reoperation Risk After the David Procedure

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• 作者：Fabrizio Settepani ; MD^a ; ^{fabrizio.settepani@humanitas.it" class="auth_mail" title="E-mail the corresponding author} ; Antioco Cappai ; MD^a ; Alessio Basciu ; MD^a ; Alessandro Barbone ; MD^a ; Monica Moz ; MD^a ; Enrico Citterio ; MD^a ; Diego Ornaghi ; MD^a ; Giuseppe Tarelli ; MD^a
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：102
• 期：5
• 页码：1503-1511
• 全文大小：983 K

文摘

We assessed whether additional cusp repair during valve-sparing aortic root replacement affects the echocardiographic mid-term results; a subgroup analysis among patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) was performed.

Methods

Between June 2002 and May 2015, 157 consecutive patients underwent valve-sparing aortic root replacement with the David technique. Thirty patients (19%) had BAV. In 19 patients (12%), cusp motion or anatomic abnormalities contributed in determining aortic regurgitation requiring an additional cusp repair. Mean follow-up was 7 ± 3.4 years.

Results

The cumulative 1-, 5-, and 12-year survival rates were 98%, 94%, and 90%, respectively. Fourteen patients (9%) required aortic valve replacement during follow-up. In 2 patients the underlying cause was bacterial endocarditis. Freedom from aortic valve reoperation was 96% at 1 year, 92% at 5 years, and 89% at 12 years. Reoperation rate was significantly higher (p < 0.001) in patients who received leaflet repair compared with patients who did not, with a freedom from reoperation at 8 years of 58% versus 94%. Among patients with BAV, those who did not require cusp repair had a freedom from reoperation at 8 years of 94%, with a significant difference compared with patients who received cusp repair (p = 0.04). Cusp repair did not affect reoperation risk in patients with tricuspid aortic valve.

Conclusions

Adjunctive cusp repair seems to affect the mid-term reoperation risk in patients with BAV and not in patients with tricuspid aortic valve. We recommend caution in using this technique in case of asymmetric BAV requiring cusp repair.