Thorac Cardiovasc Surg 2023; 71(S 01): S1-S72
DOI: 10.1055/s-0043-1761772
Monday, 13 February
Aortenklappenchirurgie

Surgical Bicuspid Aortic Valve Replacement with Rapid Deployment Aortic Valve Prosthesis in Sievers Type 0 versus Sievers Type 1 Morphology

J. von der Linden
1   Ludwig Maximilian University of Munich, München, Deutschland
,
F. Herrmann
1   Ludwig Maximilian University of Munich, München, Deutschland
,
S. Belyaev
2   Cardiac Surgery, University Hospital, LMU Munich, Munich, France
,
G. Juchem
1   Ludwig Maximilian University of Munich, München, Deutschland
,
S. Peterss
3   Kleine Düwelstraße 10, München, Deutschland
,
C. Hagl
4   Marchioninistraße 15, Mänchen, Deutschland
,
A. Dashkevich
5   Department of Cardiac Surgery, Clinic of Grosshadern, LMU, Munich, Deutschland
› Author Affiliations
› Further Information
   All articles of this category

Background: The use of rapid deployment (RD) surgical aortic valve replacement (SAVR) in bicuspid aortic valve morphology (BAV) faces several challenges due to annular asymmetry and massive calcification of the leaflets. Especially BAV with Sievers type 0 morphology, which has only two opposed raphes, and a mostly elliptical annulus must be reconstructed with caution. Nevertheless, RD SAVR might be a feasible approach for all types of BAV by following specific implantation strategies. The study aimed for retrospective feasibility analysis and comparison of RD SAVR in different bicuspid morphologies.

Method: From January 2014 to March 2022, RD SAVR was performed in more than 440 patients, including 31 patients with bicuspid aortic valve morphology (15 patients with Sievers type 0 BAV and 16 with Sievers type 1 BAV). Patients in the two cohorts had similar risk profiles, as well as similar distribution of concomitant procedures. The indication for surgery was high-grade aortic valve stenosis in most cases, pure aortic valve regurgitation in one case (Sievers type 1), and rarely combined stenosis and regurgitation (5 with Sievers type 0 and 4 with Sievers type 1). Data were collected retrospectively, and the median follow-up time was 15 months.

Results: Comparable clinical outcomes were observed in both groups. No paravalvular leak occurred, and no valvular reinterventions was required in either group. CPB and cross-clamping times were also not significantly different. Prosthetic sizes used in both groups show no significant difference (dmean: 25.0 ± 1.9 mm Sievers type 0 and 25.1 ± 1.9 mm Sievers type 1). Postoperative mean gradients were comparable in both groups (dpmax 13.9 ± 5.4 mm Hg Sievers type 0, 17.1 ± 6.7 mm Hg in Sievers type 1). There was no significant difference between the groups in postoperative pacemaker indication, postoperative stroke, or death.

Conclusion: In our collective, there is no evidence of a difference in postoperative outcome related to the type of BAV morphology. Annular symmetry can be adequately restored by precise prosthesis sizing and placement following the individual valve morphology regardless of Sievers classification of BAV, by choosing a different landmark for the initial suture is chosen from which the other two sutures are placed. In Sievers type 0, particular attention is paid to an offset depending on the coronary arteries; in Sievers type 1, the noncoronary valve can be used as a guide in most cases. RD SAVR seems to be a safe and feasible approach in any BAV morphology with good hemodynamic results and time saving in experienced hands.



Publication History

Article published online:
28 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany