Faculty Collaboration Database

Should a bicuspid aortic valve be replaced in the presence of subvalvar or supravalvar aortic stenosis? Ann Thorac Surg 1998 Oct;66(4):1337-42

Date

11/04/1998

Pubmed ID

9800830

DOI

10.1016/s0003-4975(98)00797-8

Scopus ID

2-s2.0-0032191982 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: A bicuspid aortic valve is commonly associated with other levels of left ventricular outflow tract obstruction. Providing the bicuspid aortic valve is competent and nonobstructive, repair of subvalvar or supravalvar stenosis usually focuses on the obstructive lesions, leaving the valve in situ. The aim of this report was to examine the impact of a bicuspid aortic valve on the risk of reoperation for patients undergoing operation for subvalvar or supravalvar aortic stenosis.

METHODS: Since 1976, 47 patients with supravalvar or subvalvar aortic stenosis have undergone repair. The median follow-up is 5.1 years (range, 2 months to 20.1 years). Sixteen patients (34%) had a bicuspid aortic valve that was competent and nonobstructive, and 31 (66%) had a tricuspid aortic valve.

RESULTS: Reoperation was required in 9 patients (56%) with a bicuspid aortic valve, in each involving aortic valve replacement with an autograft (3), homograft (2), or prosthesis (4). Six patients (19%) with a tricuspid aortic valve required reoperation, yet only 1 required aortic valve replacement. The freedom from valve replacement was 43% (70% confidence interval, 31% to 55%) in the bicuspid aortic valve group versus 100% (70% confidence interval, 94% to 99.5%) in the tricuspid group at 5 years (p = 0.0001). The freedom from any reoperation at 5 years was 43% (70% confidence interval, 31% to 55%) in patients with a bicuspid aortic valve versus 86% (70% confidence interval, 80% to 93%) in the tricuspid group (p = 0.02).

CONCLUSIONS: The data suggest that patients with subvalvar or supravalvar aortic stenosis and a bicuspid valve may be better palliated with a more definitive operation such as the Ross or Ross-Konno procedure.

Author List

Delius RE, Samyn MM, Behrendt DM

Author

Margaret Mary Samyn MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aortic Stenosis, Subvalvular
Aortic Valve
Aortic Valve Stenosis
Child
Follow-Up Studies
Heart Valve Prosthesis Implantation
Humans
Palliative Care
Reoperation
Risk Factors
Survival Rate
Time Factors