| Autor: |
Kerchove, Laurent de, Mastrobuoni, Stefano, Froede, Lennart, Tamer, Saadallah, Boodhwani, Munir, Dyck, Michel van, Khoury, Gebrine el, Schäfers, Hans-Joachim |
| Předmět: |
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| Zdroj: |
European Journal of Cardio-Thoracic Surgery; Aug2019, Vol. 56 Issue 2, p351-359, 9p |
| Abstrakt: |
View large Download slide View large Download slide OBJECTIVES The bicuspid aortic valve (BAV) exists in a wide variety of valve phenotypes. The aim of this study was to assess the anatomical characteristics of the different phenotypes and develop a classification system to aid surgical repair. METHODS In 178 consecutive patients operated on for aortic insufficiency or aortic dilatation in 2 centres, 11 anatomical parameters of BAV were measured by echocardiography and intraoperatively. All BAV judged potentially repairable were included in the study. RESULTS Commissural orientation correlated positively with fusion length (R 2 = 0.6, P < 0.001) and negatively with non-functional commissure height (R 2 = 0.45, P < 0.001). The cohort was divided into 3 groups according to their commissural orientation (type A: symmetrical, 160–180°, n = 73; type B: asymmetrical, 140–159°, n = 74; and type C: very asymmetrical, 120–139°, n = 31). The patterns of cusp fusion, annulus and aortic size were similar among the groups. Fusion length and the geometric height of the cusps decreased from type A to C; non-functional commissure height increased from type A to C (P < 0.05). Patient age increased from type A to type C. Isolated aortic dilatation was more frequent in type A, and severe aortic insufficiency was more frequent in types B and C (P < 0.05). Valve repair techniques and management of commissural orientation varied among the 3 groups (P < 0.05). Aortic valve replacement and residual aortic insufficiency after repair were more frequent in type C (P < 0.05). CONCLUSIONS The BAV phenotypes follow a continuous spectrum that extends from symmetrical to very asymmetrical BAV. We describe the main anatomical parameters (including commissure orientation, length of fusion and non-functional commissure height) and their variation across this spectrum. We propose a new repair-oriented classification system based on those parameters that can be used to predict valve repair techniques. This classification needs further validation with regards to surgical techniques and long-term outcomes. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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