Aortic Cusps Replacement with Bovine Pericardium for bicuspid aortic valve and Severe Aortic Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JINJing , HUAZheng-dong ,  TAOLiang

Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, P. R. China;

Corresponding author：

TAOLiang, Email: taoliangmd@gmail.com

Keywords：

Bicuspid aortic valve; Aortic regurgitation; Bovine pericardium; Aortic cusp replacement

DOI：

10.7507/1007-4848.20150135

Video：

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Objective To assess clinical results of aortic cusps replacement with bovine pericardium for bicuspid aortic valve (BAV) and severe aortic regurgitation (AR). Methods Clinical data of 79 patients with BAV and severe AR who underwent aortic cusps replacement with bovine pericardium in Wuhan Asia Heart Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 60 male and 19 female patients with their age of 38±14 years (ranged 12-78 years). All the patients were in NYHA class Ⅱ. There were 26 patients with ascending aorta and sinotubular expanding. Results No early death or major complication was recorded. Intraoperative transesophageal echocardiography showed successful repair with normal coaptation of the aortic leaflets in all the patients. AR grade was less than mild in all the patients with peak aortic valve pressure gradients of 14.2±2.8 mm Hg. All the patients were discharged from the hospital within 15 postoperative days without any adverse symptom, and were followed up for 50±16 months (ranged 9-64 months). During follow-up, all the patients were in NYHA classⅠ. There were 57 patients without AR, 16 patients with mild AR, 5 patients with moderate AR and 1 patients with severe AR. The peak of aortic valve pressure gradient was 12.4±3.2 mm Hg. The average diameter of ascending aorta was 2.7 cm in the patients with ascending aorta and sinotubular expanding. The shape of sinotubular kept normal. The height of coaptation of aortic valve was 0.58 cm by echocadiography. None of the patients died or required reoperation. The structural valve degeneration was not observed during the follow-up. Conclusion Three aortic cusps replacement with bovine pericardium can produce good hemodynamics and midterm results for patients with BAV and severe AR. The ascending aorta and sinotubular should be reduced and fixed in the patients with ascending aorta and sinotubular expanding.

Citation： JINJing, HUAZheng-dong, TAOLiang. Aortic Cusps Replacement with Bovine Pericardium for bicuspid aortic valve and Severe Aortic Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 526-530. doi: 10.7507/1007-4848.20150135 Copy

1.	Bajona P, Feindel CM. Bicuspid-aortic valve surgery: repair or replace? Curr Opin Cardiol, 2010, 25(2): 119-123.
2.	Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol, 2004, 93(5): 661-663.
3.	Cripe L, Andelfinger G, Martin LJ, et al. Bicuspid aortic valve is heritable. J Am Coll Cardiol, 2004, 44(1): 138-143.
4.	Lewin MB, Otto CM. The bicuspid aortic valve: adverse outcomes from infancy to old age. Circulation, 2005, 111(7): 832-834.
5.	Roberts WC, Ko JM, Moore TR, et al. Causes of pure aortic regurgi-ation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005). Circulation, 2006, 114(5): 422-429.
6.	Van Dyck MJ, Watremez C, Boodhwani M, et al. Transesophageal echocardiographic evaluation during aortic valve repair surgery. Anesth Analg, 2010, 111(1): 59-70.
7.	Salem DN, Stein PD, Al-Ahmad A, et al. Antithrombotic therapy in valvular heart disease--native and prosthetic: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 2004, 126(3): 457S-482S.
8.	Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg, 2009, 137(2): 286-294.
9.	David TE, Feindel CM, Webb GD, et al. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardio-vasc Surg, 2006, 132(2): 347-354.
10.	Minakata K, Schaff HV, Zehr KJ, et al. Is repair of aortic valve regur-gitation a safe alternative to valve replacement? J Thorac Cardiovasc Surg, 2004, 127(2): 645-653.
11.	Pessotto R, Wells WJ, Baker CJ, et al. Midterm results of the Ross procedure. Ann Thorac Surg, 2001, 71(5): S336-S339.
12.	Al-Halees Z, Pieters F, Qadoura F, et al. The Ross procedure is the procedure of choice for congenital aortic valve disease. J Thorac Cardiovasc Surg, 2002, 123(3): 437-442.
13.	Odim J, Laks H, Allada V, et al. Results of aortic valve-sparing and restoration with autologous pericardial leaflet extensions in conge-nital heart disease. Ann Thorac Surg, 2005, 80(2): 647-653.
14.	Aicher D, Fries R, Rodionycheva S, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg, 2010, 37(1): 127-132.
15.	Casselman FP, Gillinov AM, Akhrass R, et al. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg, 1999, 15(3): 302-308.
16.	Rao V, Van Arsdell GS, David TE, et al. Aortic valve repair for the adult congenital heart disease: A 22-year experience. Circulation, 2000, 102(19 Suppl 3): ⅡI40-ⅡI43.
17.	Schaefer BM, Lewin MB, Stout KK, et al. Usefulness of bicuspid aortic valve phenotype to predict elastic properties of the ascending aorta. Am J Cardiol, 2007, 99(5): 686-690.
18.	Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection(IRAD). J Am Coll Cardiol, 2004, 43(4): 665-669.
19.	Bruckner BA, Reardon MJ. Bicuspid aortic valve and associated aorto pathy: surgical consideration. MDCVJ, 2010, 1(1): 29-32.
20.	Borger MA, Preston M, Ivanov J, et al. Should the ascending aortabe replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg, 2004, 128(5): 677-683.
21.	金晶, 华正东, 陶凉, 等. 单个主动脉瓣叶牛心包置换术治疗儿童室间隔缺损合并主动脉瓣反流. 中国胸心血管外科临床杂志, 2014, 21(2): 216-219.
22.	Augoustides JG, Szeto WY, Bavaria JE. Advances in aortic valve repair: focus on functional approach, clinical outcomes, and central role of echocardiography. J Cardiothorac Vasc Anesth, 2010, 24(6): 1016-1020.
23.	le Polain de Waroux JB, Pouleur AC, Goffinet C, et al. Intraoperative transoesophageal echocardiographic predictors of recurrent aortic regurgitation after aortic valve repair. Circulation, 2007, 116(2): 714.
24.	Al Halees Z, Al Shahid M, Al Sanei A, et al. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothoracic Surg, 2005, 28(2): 200-205.

1. Bajona P, Feindel CM. Bicuspid-aortic valve surgery: repair or replace? Curr Opin Cardiol, 2010, 25(2): 119-123.
2. Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol, 2004, 93(5): 661-663.
3. Cripe L, Andelfinger G, Martin LJ, et al. Bicuspid aortic valve is heritable. J Am Coll Cardiol, 2004, 44(1): 138-143.
4. Lewin MB, Otto CM. The bicuspid aortic valve: adverse outcomes from infancy to old age. Circulation, 2005, 111(7): 832-834.
5. Roberts WC, Ko JM, Moore TR, et al. Causes of pure aortic regurgi-ation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005). Circulation, 2006, 114(5): 422-429.
6. Van Dyck MJ, Watremez C, Boodhwani M, et al. Transesophageal echocardiographic evaluation during aortic valve repair surgery. Anesth Analg, 2010, 111(1): 59-70.
7. Salem DN, Stein PD, Al-Ahmad A, et al. Antithrombotic therapy in valvular heart disease--native and prosthetic: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 2004, 126(3): 457S-482S.
8. Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg, 2009, 137(2): 286-294.
9. David TE, Feindel CM, Webb GD, et al. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardio-vasc Surg, 2006, 132(2): 347-354.
10. Minakata K, Schaff HV, Zehr KJ, et al. Is repair of aortic valve regur-gitation a safe alternative to valve replacement? J Thorac Cardiovasc Surg, 2004, 127(2): 645-653.
11. Pessotto R, Wells WJ, Baker CJ, et al. Midterm results of the Ross procedure. Ann Thorac Surg, 2001, 71(5): S336-S339.
12. Al-Halees Z, Pieters F, Qadoura F, et al. The Ross procedure is the procedure of choice for congenital aortic valve disease. J Thorac Cardiovasc Surg, 2002, 123(3): 437-442.
13. Odim J, Laks H, Allada V, et al. Results of aortic valve-sparing and restoration with autologous pericardial leaflet extensions in conge-nital heart disease. Ann Thorac Surg, 2005, 80(2): 647-653.
14. Aicher D, Fries R, Rodionycheva S, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg, 2010, 37(1): 127-132.
15. Casselman FP, Gillinov AM, Akhrass R, et al. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg, 1999, 15(3): 302-308.
16. Rao V, Van Arsdell GS, David TE, et al. Aortic valve repair for the adult congenital heart disease: A 22-year experience. Circulation, 2000, 102(19 Suppl 3): ⅡI40-ⅡI43.
17. Schaefer BM, Lewin MB, Stout KK, et al. Usefulness of bicuspid aortic valve phenotype to predict elastic properties of the ascending aorta. Am J Cardiol, 2007, 99(5): 686-690.
18. Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection(IRAD). J Am Coll Cardiol, 2004, 43(4): 665-669.
19. Bruckner BA, Reardon MJ. Bicuspid aortic valve and associated aorto pathy: surgical consideration. MDCVJ, 2010, 1(1): 29-32.
20. Borger MA, Preston M, Ivanov J, et al. Should the ascending aortabe replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg, 2004, 128(5): 677-683.
21. 金晶, 华正东, 陶凉, 等. 单个主动脉瓣叶牛心包置换术治疗儿童室间隔缺损合并主动脉瓣反流. 中国胸心血管外科临床杂志, 2014, 21(2): 216-219.
22. Augoustides JG, Szeto WY, Bavaria JE. Advances in aortic valve repair: focus on functional approach, clinical outcomes, and central role of echocardiography. J Cardiothorac Vasc Anesth, 2010, 24(6): 1016-1020.
23. le Polain de Waroux JB, Pouleur AC, Goffinet C, et al. Intraoperative transoesophageal echocardiographic predictors of recurrent aortic regurgitation after aortic valve repair. Circulation, 2007, 116(2): 714.
24. Al Halees Z, Al Shahid M, Al Sanei A, et al. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothoracic Surg, 2005, 28(2): 200-205.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Aortic Cusps Replacement with Bovine Pericardium for bicuspid aortic valve and Severe Aortic Regurgitation

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