Our Summary

This study looks at the results of replacing the root of the aorta - the main artery that carries blood from the heart to the rest of the body - while keeping the patient’s own aortic valve. It compares results between those who have a bicuspid aortic valve (BAV, two leaflets or ‘flaps’), and those with a tricuspid aortic valve (TAV, three leaflets).

Between 2002 and 2017, 92 adults had this procedure with a BAV, and 515 with a TAV, at the Cleveland Clinic. To make a fair comparison, the researchers matched 71 pairs of patients based on 28 factors before their operation. They then looked at the risk of death, complications, data from heart scans, need for further surgery on the aortic valve, and overall survival.

Results showed that the procedure was safe for both BAV and TAV patients, with a low risk of complications. Five years after the operation, a small number of patients in both groups had severe leakage of the aortic valve, with slightly more in the BAV group. The BAV group had higher pressure gradients (a measure of blood flow) and a higher left ventricular mass index (a measure of heart muscle size). The percentage of patients free from the need for further surgery on the aortic valve was slightly lower in the BAV group. Survival rates were very high in both groups.

In summary, replacing the aortic root while sparing the aortic valve is a safe procedure with good medium-term results for both BAV and TAV patients. However, BAV patients showed some less favourable measures and were more likely to need further valve surgery, so ongoing monitoring will be needed.

FAQs

  1. What were the outcomes of aortic root replacement with BAV reimplantation compared to TAV reimplantation?
  2. What was the mortality rate among the patients who underwent BAV and TAV reimplantations?
  3. What were the five-year results for patients in the BAV and TAV groups?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about valve replacement is to continue with long-term surveillance and follow-up appointments to monitor for any changes in aortic valve function, gradients, and ventricular remodeling. This will help ensure early detection of any potential issues and allow for timely intervention if needed.

Suitable For

Patients with aortic root aneurysms and bicuspid aortic valves or tricuspid aortic valves are typically recommended for valve replacement. This study found that aortic root replacement with valve-sparing reimplantation of bicuspid aortic valves had similar outcomes to reimplantation of tricuspid aortic valves in terms of mortality, morbidity, aortic regurgitation, and freedom from reoperation. However, bicuspid aortic valve patients had higher mean gradients, less ventricular reverse remodeling, and more aortic valve reoperations, indicating the need for continued long-term surveillance in these patients.

Timeline

Before valve replacement:

  1. Patient presents with symptoms such as chest pain, shortness of breath, fatigue, or heart palpitations.
  2. Patient undergoes diagnostic tests such as echocardiogram, CT scan, or cardiac catheterization to determine the extent of valve dysfunction.
  3. Patient and healthcare team discuss treatment options, including valve repair or replacement.
  4. Patient undergoes preoperative evaluation and preparation for surgery.

After valve replacement:

  1. Patient undergoes valve replacement surgery, either with a mechanical or biological valve.
  2. Patient is monitored closely in the intensive care unit for a period of time post-surgery.
  3. Patient begins rehabilitation and recovery process, including physical therapy and medication management.
  4. Patient undergoes regular follow-up appointments with healthcare team to monitor valve function and overall heart health.
  5. Patient may experience improvements in symptoms such as improved exercise tolerance and reduced risk of complications related to valve dysfunction.
  6. Patient may need to undergo additional procedures or interventions in the future, depending on the type of valve replacement and individual health factors.

What to Ask Your Doctor

  1. What are the risks and benefits of valve-sparing reimplantation surgery compared to other types of valve replacement procedures?
  2. How long does the recovery process typically take after valve-sparing reimplantation surgery?
  3. What follow-up care will be needed after the surgery, and how often will I need to have check-ups or echocardiograms?
  4. What lifestyle changes or restrictions will I need to follow after the surgery?
  5. What are the chances of needing a repeat surgery in the future after valve-sparing reimplantation?
  6. Are there any specific symptoms or warning signs I should watch for that may indicate a complication with the valve-sparing reimplantation?
  7. How long can I expect the valve-sparing reimplantation to last before needing to be replaced again?

Reference

Authors: Mokashi SA, Rosinski BF, Desai MY, Griffin BP, Hammer DF, Kalahasti V, Johnston DR, Rajeswaran J, Roselli EE, Blackstone EH, Svensson LG. Journal: J Thorac Cardiovasc Surg. 2022 Jan;163(1):51-63.e5. doi: 10.1016/j.jtcvs.2020.02.147. Epub 2020 May 11. PMID: 32684389