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Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: The role of valve phenotype in 1362 patients  Hans-Hinrich Sievers,

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Presentation on theme: "Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: The role of valve phenotype in 1362 patients  Hans-Hinrich Sievers,"— Presentation transcript:

1 Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: The role of valve phenotype in 1362 patients  Hans-Hinrich Sievers, MD, Ulrich Stierle, MD, Salah A. Mohamed, PhD, MD, Thorsten Hanke, MD, Doreen Richardt, MD, Claudia Schmidtke, MD, Efstratios I. Charitos, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 148, Issue 5, Pages e3 (November 2014) DOI: /j.jtcvs Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Schematic presentation of the classification system of the most frequent bicuspid aortic valve (BAV) phenotypes according to (A1) the number of raphes or fusions and (A2) the spatial position of the commissures for type 0 and the raphes for types 1 and 2/unicuspid as viewed by the surgeon on the right side of the patient. B, The spatial orientation of the characteristic of a BAV, with the fish mouth-like bifoliate valve opening shown. C, The developmental state of the commissures. Thick line in the circle, Raphe; small circles, coronary ostia; shaded, valve opening area; L, left; R, right; ap, anteroposterior; lat, lateral; N, noncoronary; LR, raphe between left coronary and right coronary sinuses; RN, raphe between right coronary and noncoronary sinuses. The Journal of Thoracic and Cardiovascular Surgery  , e3DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 The probability (y-axis) that a patient will belong to 1 of the ascending aorta (AA) groups (no intervention, aortoplasty [AoP], AA replacement [AAR]), given a certain preoperative AA diameter (x-axis). For example, at an AA diameter of 40 mm, the probability for a patient to undergo AA intervention (AoP or AAR) was In contrast, at an AA diameter of 45 mm, the probability of AA intervention increased to 0.57. Even at smaller diameters, intervention (AAR or AoP) was performed, indicating that not only the diameter was decisive in decision making, but also the other parameters, for a multifactorial individualized approach. BSA, Body surface area; F, Fazel13; BAV, bicuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery  , e3DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Probability of ascending aorta replacement in relation to bicuspid aortic valve (BAV) phenotype. Patients with BAV type 2/unicuspid underwent interventions significantly more often at a certain diameter than did those with BAV type 1. The Journal of Thoracic and Cardiovascular Surgery  , e3DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Graphic depiction of the decision tree investigating our ascending aorta (AA) management process, the effect of the preoperative variables (AA diameter, body surface area [BSA], bicuspid aortic valve [BAV] type), and the resulting patterns of AA intervention. AAR, AA replacement; AoP, aortopathy. The Journal of Thoracic and Cardiovascular Surgery  , e3DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

6 Figure E1 Schematic presentation of the surgical technique for aortopathy. The eccentric part of the ascending aorta is plicated between 2 Teflon felts using a mattress and over and over continuous suture. The Journal of Thoracic and Cardiovascular Surgery  , e3DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

7 Figure E2 Survival (upper graphs) and freedom from reoperation (lower graphs) in relation to (A) bicuspid aortic valve (BAV) phenotypes and (B) management of ascending aorta. n.s., Not significant. The Journal of Thoracic and Cardiovascular Surgery  , e3DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

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