Valve Sparing Root Replacement in Bicuspid Aortic Valve Disease

Abstract

A dysfunctional bicuspid aortic valve (BAV) with associated an aortic root aneurysm represents complex pathology with multiple options for surgical repair. Traditionally Bentall aortic root replacement has been the gold standard to ensure a properly functioning valve and minimize the risk of recurrent root disease. Given the known disadvantages of prosthetic valve conduits with either a mechanical or bioprosthetic valve in these often young patients, there has recently been increasing interest and application of valve-sparing operations in BAV patients with aortic root enlargement. Over the pasts 15 years, our institution has been able to safely perform valve-sparing root replacement in select patients with diseased bicuspid aortic valve and root aortopathy. The outcomes are excellent and long-term follow-up data shows 10-year freedom from aortic valve or root replacement at 96%. This success can be attributed to appropriate patient selection, sound operative technique with meticulous post-operative care as well as a lifetime post-operative follow-up strategy. Here in we describe our operative technique and key tenets to ensure optimal patient outcomes.