Mid-term Results of the Congenital Bicuspid Aortic Valve Repair / 대한흉부외과학회지

ABSTRACT

BACKGROUND: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. MATERIAL AND METHOD: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). RESULT: Mean age was 41+/-14 years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of 38+/-17 months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from 1.9+/-0.6 to 1.2+/-0.5 (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from 45+/-9 and 67+/-10 to 37+/-10 and 56+/-10, respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative (3.1+/-1.2) to post-bypass (0.9+/-0.7). However, the grade at last follow-up (1.7+/-1.1) was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. CONCLUSION: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.