• Catalin Constantin Badiu, Walter Eichinger, Sabine Bleiziffer, Grit Hermes, Ina Hettich, Markus Krane, Robert Bauernschmitt, and Rüdiger Lange.
• German Heart Centre Munich, Department of Cardiovascular Surgery, Clinic at Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany. badiu@dhm.mhn.de
• Eur J Cardiothorac Surg. 2010 Nov 1; 38 (5): 515-22.

ObjectiveTo examine the results of root replacement with aortic valve-sparing in patients with bicuspid aortic valve (BAV) or severe aortic regurgitation (AR).MethodsBetween 2000 and 2009, 102 patients (mean age 47±17.5 years) underwent aortic valve-sparing procedures for ascending aortic aneurysm or dissection. Patients were assigned to three different groups according to the aortic valve pathology: BAV (n=11), tricuspid aortic valve (TAV) with AR less than severe (n=51), and TAV with severe AR (n=40). Remodelling of the aortic root was performed in 28 (27.5%) patients, reimplantation of the aortic valve in 74 (72.5%) and a concomitant cusp repair in 30 (29.4%). All patients were prospectively studied with annual clinical assessment and echocardiography.ResultsThe overall actuarial 5-years' survival was 97.8±1.5% without differences between the groups. Actuarial 5-years' freedom from aortic valve-related re-operation was 92.2±3.2% in all patients, 100% in patients with a BAV, 98±1.9% in patients with a TAV and AR less than severe, and 82.7±7.5% in patients with a TAV and severe AR (p=0.07). The overall actuarial freedom from AR, which was more than mild at 5 years was 73.3±7.7%, being significantly (log-rank test: p=0.005) lower for patients presenting with TAV and severe AR (49.9±16.4%).ConclusionsThe outcome in terms of survival is excellent for all patients after aortic valve-sparing operations. There is no significant difference in terms of re-operation between patients, who presented with BAV or TAV. Re-operation rates are higher for patients who presented with severe AR but these rates do not reach statistical significance. Hence, root replacement with aortic valve-sparing should be offered even in the presence of a BAV or severe AR.Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

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