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Ann Thorac Surg 2004;77:1998-2003
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Is a bicuspid aortic valve a risk factor for adverse outcome after an autograft procedure?

^a Cardiothoracic Surgery, Rotterdam, The Netherlands
^b Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands

Accepted for publication December 2, 2003.

^* Address reprint requests to Dr Bogers, Department of Cardiothoracic Surgery, Thoraxcentre, Bd 158, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
e-mail: a.j.j.c.bogers{at}erasmusmc.nl

BACKGROUND: Recently, bicuspid aortic valve disease is posed to be a possible risk factor for dilatation of the pulmonary autograft.

METHODS: Analysis of all 123 patients in our prospective cohort with their native aortic valve in situ at the autograft procedure.

RESULTS: The bicuspid aortic valve group (n = 81) had more males (p = 0.05), prior cardiac surgery (p = 0.02), prior aortic valve balloon dilatation (p = 0.01), aortic stenosis (p = 0.03), and less deterioration of left ventricular function (p = 0.02) than the tricuspid group (n = 42). Hospital mortality occurred in 3 patients (bicuspid 2, tricuspid 1). The follow-up was 99% complete (median, 5.3 years; SD, 3.5; range, 0.1 to 13.4) with a total of 674 patient years. During follow-up 4 patients died (bicuspid 2, tricuspid 2). Overall survival was 95% (95% confidence interval [CI], 89% to 98%) at 5 and 10 years. Seven patients required reoperation for autograft failure, all structural. Freedom from autograft reintervention was 97% (95% CI, 92% to 100%) at 5 years and 89% (95% CI, 79% to 98%) at 10 years. There were no differences in outcome between the groups. Four patients required reoperation for allograft failure, all structural. Freedom from allograft reoperation was 99% (95% CI, 97% to 100%) at 5 years and 91% (95% CI, 82% to 100%) at 10 years. There was no difference between the groups.

CONCLUSIONS: An autograft procedure in patients with a bicuspid aortic valve is justified. Bicuspid aortic valve disease is not a contraindication for an autograft procedure. Patients with a bicuspid aortic valve will meet the limitations of the autograft procedure in the same frequency as the overall autograft population.

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