Is There a Difference in the Long-Term Results after Repair of Tricuspid and Bicuspid Aortic Valves?

Objectives: Aortic valve repair (AVR) is an alternative to prosthetic valve replacement in patients with aortic regurgitation (AR). However, durability of the repair result is an ongoing reason for concern, especially in patients with bicuspid aortic valves (BAV). Aim of this study was to evaluate long-term results after AVR in patients with either bi- or tricuspid aortic valve (TAV) with regard to reoperation rates, recurrence of regurgitation and survival.

Methods: Between November 2004 and March 2016, a total of 150 patients underwent AVR for AR including elective and emergency referrals. Patients were retrospectively identified in our institutional database and followed by echo, mail and telephone. Follow-up was complete in all patients.

Results: Mean age was 55.6 ± 15.6 years and 119 patients (79.3%) were male. TAV was found in 90 patients (60%). Moderate or severe AR was present in 115 patients (76.7%). Concomitant procedures were performed in 102 cases (68%).

Mean follow-up time was 8.7 ± 0.3 years. At follow-up, mean left ventricular end- diastolic and -systolic diameters had significantly decreased compared to preoperative diameters (58.9 ± 8.5 vs. 53.3 ± 6.2 [p < 0.001] and 38.3 ± 8.5 vs. 34 ± 6.7 mm [p = 0.025]). Less than moderate AR was detected in 114 patients (76%). Freedom from reoperation at 1, 5, and 10 years was 90.4, 80.6, and 80.6%, respectively. Survival at 1, 5, and 10 years was 95.9, 93.8, and 83.6%, respectively. No significant difference in reoperation rates was found between BAV and TAV patients (p = 0.91).

Conclusions: The vast majority of patients showed a sustained competent aortic valve, as well as improved ventricular function after isolated aortic valve repair with low reoperation rates up to 10 years. Reoperation rates were comparable in both bicuspid and tricuspid aortic valves.