Table 2. Summary of major reports that present data on patients undergoing bicuspid aortic valve repair.
| Author, year, country | Demographics | Study design | Outcomes | Results |
|---|---|---|---|---|
| Aicher et al. [2011], Germany (11) | n=316, male 84.8%, age range 3–79 years, aortic dissection 8%, severe AI 72.8% | Retrospective case series—Effect of valve configuration on outcomes of BAV repair | In-hospital mortality | 0.63% |
| 10-year overall survival | 92% | |||
| 10-year freedom from AI >2 | 81% | |||
| 10-year freedom from reoperation | 81% | |||
| 10-year freedom from AVR | 84% | |||
| Aicher et al. [2013], Germany (12) | n=559, mean age 47.2±14.1 years, male 86.8% | Retrospective cohort study—Isolated BAV repair vs. BAV repair with suture annuloplasty | In-hospital mortality | 0.5% |
| Reoperation for recurrent AI | 9.7% | |||
| Reoperation for aortic stenosis | 0.4% | |||
| 10-year freedom from reoperation | 82% | |||
| Alsoufi et al. [2005], Canada (4) | n=71, male 87.3%, mean age 41.5±13.2 years | Retrospective case series—Aortic valve repair for AI secondary to BAV inclusive of aortic remodeling and replacement | In-hospital mortality | 0% |
| Postoperative AI >2 | 0% | |||
| 8-year overall survival | 96.7% | |||
| Freedom from TE/hemorrhage | 100% | |||
| 8-year freedom from reoperation | 82.3% | |||
| 8-year freedom from endocarditis | 90% | |||
| 8-year freedom from AI >2 | 44.2% | |||
| Ashikhmina et al. [2010], USA (13) | n=108, male 91%, mean age 41 years | Retrospective case series—BAV repair, excludes valve-sparing root replacements | In-hospital mortality | 0% |
| 10-year overall survival | 87% | |||
| 10-year freedom from reoperation | 64% | |||
| 10-year freedom from AVR | 49% | |||
| Badiu et al. [2010], Germany (14) | n=11, male 100%, mean age 37±15.8 years, aortic dissection 0%, Marfan 0% | Retrospective cohort study—Aortic valve repair for AI: BAV vs. TAV | Operative mortality | 0% |
| 5-year overall survival | 100% | |||
| 5-year freedom from reoperation | 100% | |||
| 5-year freedom from AI | 57.1% | |||
| 5-year freedom from TE events | 95.9% | |||
| Bavaria et al. [2015], USA (15) | n=129 | Retrospective cohort study—Valve-sparing root reimplantation: BAV vs. TAV | Operative mortality | 0% |
| 5-year overall survival | 99%±1% | |||
| Boodhwani et al. [2010], Belgium (16) | n=122, male 92%, mean age 44±11 years, AI >2 86.1% | Retrospective case series—BAV repair with either AI or dilatation of proximal ascending aorta | In-hospital mortality | 0% |
| Discharge AI <2 | 93% | |||
| 8-year overall survival | 97%±2% | |||
| 5-year freedom from AI >2 | 94%±3% | |||
| 8-year freedom from AV reoperation | 83%±5% | |||
| 8-year freedom from AVR | 90%±5% | |||
| 8-year freedom from TE and bleeding | 96%±2% | |||
| Casselman et al. [1999], USA (17) | n=94, male 93%, mean age 38±10 years | Retrospective case series—Aortic valve repair for BAV with AI | Immediate reoperation | 8.5% |
| Immediate postoperative AI >2 | 2.1% | |||
| 7-year freedom from AV reoperation | 84% | |||
| David et al. [2017], Canada (18) | N=333, male 78%, mean age 46±5 years, BAV n=45 | Prospective case series—Patients undergoing reimplantation for root aneurysm | 20-year Freedom from reoperation | 96.9%±1.3% |
| 20-year survival | 72%±4% | |||
| Thromboembolism free survival | 92.5%±2.8% | |||
| de Kerchove et al. [2009], Belgium (19) | n=54 | Retrospective cohort study—Impact of preoperative AI on aortic valve-sparing surgery (limited BAV data) | 5-year freedom from AI > 2 | 98%±2% |
| 8-year freedom from AV reoperation | 91%±9% | |||
| de Kerchove et al. [2011], Belgium (20) | n=161 | Retrospective cohort study—BAV repair: subcommissural annuloplasty/no annuloplasty vs. reimplantation | In-hospital mortality | 0% |
| 6-year overall survival | 98%±3% | |||
| 6-year freedom from reoperation | ||||
| Subcommissural annuloplasty/no annuloplasty | 90%±8% | |||
| Reimplantation | 100% | |||
| 6-year freedom from AI >2+ | ||||
| Subcommissural annuloplasty/no annuloplasty | 64%±15% | |||
| Reimplantation | 95%±5% | |||
| Doss et al. [2010], Germany (21) | n=66: (I) n=49; (II) n=17. Mean age 41.2±12 years: (I) 58 years; (II) 39 years. Male 78.8%: (I) 82.3%; (II) 77.6%. AI >2+ 95.4%: (I) 82.3%; (II) 100% |
Retrospective cohort study—BAV and AI: (I) patch augmentation plus reduction aortoplasty vs. (II) modified David procedure | 5-year mortality | (I) 2.0%, (II) 0% |
| 5-year reoperation | (I) 2.0%, (II) 0% | |||
| 5-year endocarditis | (I) 2.0%, (II) 0% | |||
| 5-year conduction disturbance/thromboembolism/AI >1 | (I) 0%, (II) 0% | |||
| Fattouch et al. [2017], Italy (22) | n=152, mean age 55±7 years, male 72%, AI > 2+ 100% | Retrospective case series—BAV with AI with or without concomitant root surgery | In-hospital death | 1.3% |
| 5-year overall survival | 88.6%±3.6% | |||
| 5-year freedom from recurrent AI >2 (requiring reoperation) | 93%±3.1% | |||
| 5-year freedom from reintervention | ||||
| Aortic valve repair & reimplantation | 98.4%±1.6% | |||
| Aortic valve repair & subcommissural annuloplasty | 93.3%±6.4% | |||
| Aortic valve repair alone | 82.6%±9.6% | |||
| Kin et al. [2003], Japan (23) | n=19, male 98%, mean age 42±17 years | Retrospective case series—Aortic valve repair for AI secondary to BAV | Hospital death | 5.2% |
| Early reoperation | 5.2% | |||
| Reoperation at follow-up | 15.8% | |||
| Late death | 5.2% | |||
| 5-year overall survival | 90%±7% | |||
| 5-year freedom from AV reoperation | 76%±23% | |||
| Kari et al. [2016], Germany (24) | N=1015, male 74%, mean age 53±16 years, BAV =163 (16%) | Multicenter cohort VSRR | Early survival | 98% |
| 8-year freedom from AVR | 84% | |||
| 8-year survival | 95% | |||
| Kari et al. [2013], USA (25) | n=75, male 80%, mean age 45±10 years | Retrospective case series—BAV for AI with or without cusp repair | Actuarial survival | 99%±2% |
| Freedom from reoperation | 90%±5% | |||
| Freedom from AR >2+ | 100% | |||
| Karciaskas et al. [2019], UK (26) | N=92, BAV =29 | Retrospective case series | 10-year freedom from AR >2+ | 75%±8% |
| 10-year freedom from AV reoperation | 83%±7% | |||
| Overall survival | 90%±4% | |||
| Kayatta et al. [2019] USA (27) | N=60, male 80%, mean age 42±11 years | Prospective case series—BAV with reimplantation | Freedom from 2+ AI | 97% |
| Freedom from AVR | 96% | |||
| Lansac et al. [2017], France (28) | Overall n=177, BAV =59 (33%) | Prospective multicenter registry—Implementation of systematic height assessment in 2007 | 30-day mortality | 2.9% |
| 7-year freedom from reoperation | 99.5% | |||
| Freedom from 3+ AI | 100% | |||
| Freedom from valve related events | 96% | |||
| Magro et al. [2017], Portugal (29) | n=42, mean age 50 years | Retrospective case series—Valve-sparing root reimplantation for aortic annular ectasia (limited BAV data) | Long term survival | Not reported |
| Freedom from reintervention | ||||
| Mangini et al. [2010], Italy (30) | n=31, mean age 49.9 ±17.3 years, male 83.9%, AI >1 96.8% | Prospective case series—BAV repair for AI | 30-day operative mortality | 3.2% |
| Discharge AI >1 | 3.2% | |||
| 5-year freedom from reoperation | 96.6% | |||
| Mastrobuoni et al. [2019], Belgium (31) | N=440, BAV =177 (40.2%), mean age 49±15 years | Observational cohort study of VSRR | In-hospital mortality | 0.7% |
| 10-year survival | 79% | |||
| 10-year freedom from reoperation | 89% | |||
| Miller [2015], USA (32) | n=331, Stanford modification 85.8%, Marfan 38.4%, Loeys Dietz 3.6% | Retrospective case series—Stanford modification for valve-sparing root replacement: BAV vs. TAV | Operative mortality | 0.6% |
| 10-year freedom from AV reoperation | 92%±4% | |||
| 10-year freedom from structural valve deterioration | 96%±2% | |||
| Schafers et al. [2010], Germany (33) | n=153, mean age 51±12 years, male 86.9%, preoperative AI grade 2.6±0.8, aortic dissection 3.9% | Retrospective case series—Valve-sparing root replacement for BAV and AI | In-hospital mortality | 0.7% |
| 10-year overall survival | 91% | |||
| 10-year freedom from AI >1 | 90% | |||
| 10-year freedom from reoperation | 95% | |||
| 10-year freedom from AVR | 97% | |||
| TE events | 2.6% | |||
| Endocarditis | 0% | |||
| 10-year freedom from AV complications | 91% | |||
| Schneider et al. [2017], Germany (8) | n=357, male 90.8%, AI ≥3+ 74.2% | Retrospective case series—Combined BAV repair and root remodeling | In-hospital mortality | 0.6% |
| 15-year overall survival | 81% | |||
| Reoperation for recurrent AI | 6.7% | |||
| Reoperation for aortic stenosis | 1.7% | |||
| 15-year cumulative incidence of reoperation | 21.7% | |||
| Svensson et al. [2014], USA (34) | N=728, mean age 42±12 years | Retrospective case series—Combined BAV repair techniques | 10-year freedom from reoperation | 78% |
| 10-year survival | 94% |
BAV, bicuspid aortic valve.