Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair Laurent de Kerchove, MD,

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Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair Laurent de Kerchove, MD, Munir Boodhwani, MD, MMSC, David Glineur, MD, Michel Vandyck, MD, Jean-Louis Vanoverschelde, MD, PhD, Philippe Noirhomme, MD, Gebrine El Khoury, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 6, Pages 1430-1438 (December 2011) DOI: 10.1016/j.jtcvs.2011.08.021 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Definition of the study groups. BAV, Bicuspid aortic valve; VAJ, ventriculoaortic junction; SCA, subcommissural annuloplasty. 1Root remodeling was performed with replacement of a single sinus of Valsalva (partial remodeling) in 14 patients and with replacement of both sinuses (complete remodeling) in 3 patients. 2Reimplantation was performed with Dacron polyester tube graft in 23 patients (31%) and with a Gelweave Valsalva graft (Vascutek Ltd, a Terumo Company, Renfrewshire, Scotland) in 51 patients (69%). A, Illustration of subcommissural annuloplasty suture (black arrow). B, Illustration of proximal circumferential suture line (white arrows) in reimplantation technique. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1430-1438DOI: (10.1016/j.jtcvs.2011.08.021) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan-Meier actuarial survival curves comparing group 1 and group 2. A, Overall survival (P = .9). B, Freedom from aortic valve reoperation (P = .025). C, Freedom from recurrent aortic insufficiency greater than 2+ (P = .002). D, Freedom from recurrent aortic insufficiency greater than 1+ (P = .0006). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1430-1438DOI: (10.1016/j.jtcvs.2011.08.021) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Illustration of ventriculoaortic junction redilatation in a 30-year-old man undergoing bicuspid aortic valve repair with subcommissural annuloplasty, raphe resection and direct closure, and resuspension of both cusps with polytetrafluoroethylene. Echocardiographic long-axis views show the ventriculoaortic junction diameter (arrows) before bicuspid aortic valve repair (A, 29 mm), after bicuspid aortic valve repair (B, 24 mm), and 6.5 years later, before bicuspid aortic valve reoperation for recurrent aortic insufficiency (C, 29 mm). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1430-1438DOI: (10.1016/j.jtcvs.2011.08.021) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions