Aortic Valve Repair of a Stenotic Unicuspid Aortic Valve in Young Patients

Ann Thorac Surg. 2018 May;105(5):1351-1356. doi: 10.1016/j.athoracsur.2017.12.031. Epub 2018 Jan 31.


Background: The unicuspid aortic valve (UAV) is a well-described pediatric congenital abnormality, with incidence of 0.02% in the general population. Bicuspidization has been described as a potential surgical option to repair this defect.

Methods: Seventeen symptomatic young patients with a unicuspid valve combined with either valve insufficiency or valve stenosis underwent aortic valve (AV) bicuspidization procedure by using an equine pericardium. In addition to bicuspidization, 8 patients underwent aortic ring implantation and 5 patients underwent supracoronary replacement of the aorta.

Results: Our results show safety of the bicuspidization procedure. No deaths occurred during our average follow-up period of 26 months. Freedom from reoperation for any valve-related reason was 100% during this follow-up period. We observed a statistically significant increase in the AV area from 0.8 ± 0.1 cm2 to 2.8 ± 0.7 cm2 (p < 0.01), a statistically significant decrease in the mean systolic pressure gradient from 36 ± 13.3 mm Hg to 9 ± 4 mm Hg (p < 0.001), a statistically significant decrease in aortic insufficiency grade from 2.1 ± 1.0 to 0.6 ± 0.7 (p < 0.01) before and after bicuspidization, respectively, and a statistically significant decrease in the left ventricular end-diastolic diameter from 49.88 ± 5.11 mm to 40.46 ± 7.20 mm (p < 0.0005) and a statistically significant increase of the left ventricular ejection fraction from 56% ± 8.20% to 64% ± 7.83% at the time of follow-up.

Conclusions: From our study, bicuspidization is an attractive surgical option to repair UAV, particularly in young patients who do not want to be subjected to long-term anticoagulation therapy or who refuse a more traditional surgical approach, such as Ross procedure, for reasons described previously.

MeSH terms

  • Adult
  • Age Factors
  • Animals
  • Aortic Valve / surgery
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Insufficiency / surgery*
  • Aortic Valve Stenosis / etiology
  • Aortic Valve Stenosis / surgery*
  • Bicuspid Aortic Valve Disease
  • Bioprosthesis*
  • Cohort Studies
  • Female
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / surgery*
  • Heart Valve Diseases / complications
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis Implantation*
  • Heart Valve Prosthesis*
  • Horses
  • Humans
  • Male
  • Pericardium
  • Treatment Outcome
  • Young Adult