Document Detail

Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease.
MedLine Citation:
PMID:  23260433     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The durability of valve-sparing aortic root replacement with or without cusp repair in patients with bicuspid aortic valve (BAV) disease is questioned. We analyzed the results of 75 patients with a BAV undergoing Tirone David reimplantation valve-sparing aortic root replacement.
METHODS: Average age was 45 ± 10 years; 80% were male; 31% had 2+ or greater aortic regurgitation (AR); annular diameter averaged 28 ± 3 mm; 32% had a Sievers' type 0 BAV, and 66% underwent concomitant cusp repair (usually cusp free margin shortening) to correct prolapse. Early (6 ± 3 days) and late (2.9 ± 1.7, 1-10 years) postoperative echocardiographic results were compared (cumulative echocardiographic follow-up, 190 patient-years; median late interval, 2 years [interquartile range, 0.68, 4.2]). Seven patients remained at risk beyond 6 years. Clinical outcome and valve function were analyzed using log-rank calculations.
RESULTS: Actuarial survival was 99% ± 2%; freedom from reoperation was 90% ± 5%, infection 98% ± 2%, and stroke 100% at 6 years. After initial improvement in degree of AR (P < .001), minor subclinical progression of AR was observed (P > .5); however, freedom from AR of more than 2+ was 100%. Cusp free margin shortening was not associated with valve deterioration, but commissural suspensory polytetrafluoroethylene neochord creation (n = 4) portended a higher probability of recurrent AR (P = .025).
CONCLUSIONS: After David procedure and cusp repair in patients with a BAV, midterm clinical and valve function outcomes were favorable out to 6 years. More follow-up is required to determine long-term valve durability and the hazard of other clinically important late adverse events, including eventual reoperation, to beyond 10 years.
Fabian A Kari; David H Liang; John-Peder Escobar Kvitting; Elizabeth H Stephens; R Scott Mitchell; Michael P Fischbein; D Craig Miller
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-12-20
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  145     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-04-25     Revised Date:  2013-04-30    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S35-40.e1-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Department of Cardiovascular and Thoracic Surgery, Stanford University Medical School, Stanford, Calif 94305-5247, USA.
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MeSH Terms
Aortic Valve / physiopathology,  surgery*,  ultrasonography
Aortic Valve Insufficiency / surgery
Blood Vessel Prosthesis Implantation* / adverse effects,  mortality
Cardiac Valve Annuloplasty* / adverse effects,  mortality
Communicable Diseases / etiology,  surgery
Disease-Free Survival
Heart Defects, Congenital / mortality,  physiopathology,  surgery*,  ultrasonography
Kaplan-Meier Estimate
Middle Aged
Replantation* / adverse effects,  mortality
Retrospective Studies
Risk Factors
Stroke / etiology,  surgery
Time Factors
Treatment Outcome
Young Adult

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