Radically New Insights on Bicuspid Aortic Valve Repair Influence Practice Worldwide

Joseph E. Bavaria, MD

Joseph E. Bavaria, MD

With ever-changing information emerging about the pathophysiology of bicuspid aortic valve (BAV), as well as the anatomy and physiology of the aortic root, it’s essential for cardiac surgeons to familiarize themselves with the latest, state-of-the-art BAV repair paradigms.

Approximately 0.5%–1.0% of the world’s population is afflicted with BAV. And the majority of patients who develop related disorders tend to be in the prime of their lives, as young as 45 years old. 

“With so many patients needing intervention, we felt it was imperative to do a deep dive into bicuspid valve repair with aortic root aneurysm,” said STS Past President Joseph E. Bavaria, MD, from the Hospital of the University of Pennsylvania in Philadelphia. “This is an important tool in the armamentarium of surgeons across the globe.” 

A Monday session, which was developed by STS and the European Association for Cardio-Thoracic Surgery, will include detailed videos and precise how-to guidelines that will prove beneficial for both new and experienced surgeons. The session will be moderated by Dr. Bavaria and Davide Pacini, MD, from St. Orsola-Malpighi Hospital in Bologna, Italy.

STS/EACTS: Bicuspid Aortic Valve Repair with Aortic Root Aneurysm—Techniques and Outcomes

Monday
7:00 a.m. – 9:00 a.m.
Room 225

“Several experts from North America and Europe will cover updated anatomical classifications, new repair techniques, surgical indications, and mid- and long-term outcomes,” said Dr. Pacini. 

He acknowledged that there are several schools of thought when it comes to BAV repair—some centers prefer symmetric reconstruction, while others use an asymmetrical approach—but emphasized that treatments should be customized for each patient.

BAV repair becomes even more complex when it is performed in the setting of a root aneurysm. “There are several methodologies with merit. We will review the technical and outcome differences between reimplantation and remodeling,” said Dr. Bavaria. 

Davide Pacini, MD

Davide Pacini, MD

Stabilization of the annulus and preserving the mobility of the leaflet are hot topics for the BAV repair community. “I think we will hear more about the increasing importance of 4D MRI in assessing the aortic root’s fluid dynamic,” said Dr. Pacini.

Monday’s session also may generate a heated debate about the fundamental BAV question: repair or replace? Dr. Bavaria suggested that a good repair is always better than a replacement. 

“Giving a 70-year-old a prosthetic valve is okay, but we don’t want to consign a 40-year-old to an early death with a new valve, if possible,” said Dr. Bavaria. “However, it’s also essential to know when not to repair.”

Dr. Pacini noted that a well-functioning prosthetic valve is always better than a badly repaired native aortic valve. “A good repair can be achieved if the leaflets are well preserved. The results will not be good if the leaflets are calcified or restricted,” he said. 

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