1. Bicuspid Aortic Valve Impacts the Incidence of Induced Leaflet Prolapse and Leaflet Repair Following Aortic Valve-Sparring Root Reconstruction for Aortic Root Aneurysm Joel Price, Laurent De Kerchove, David Glineur and Gebrine El Khoury Cliniques Universitaires Saint Luc, Brussels, Belgium

2. Background Reimplantation AVSRR is the gold-standard treatment for aortic root aneurysm with normal aortic leaflets Numerous techniques are described All change the native geometry of the functional aortic annulus This can potentially result in leaflet prolapse and aortic insufficiency

3. Purpose To define the incidence of induced aortic valve dysfunction following AVSRR for root aneurysm in the absence of AI The incidence of induced AI my be different in bicuspid vs tricuspid valves

4. Methods Retrospective study 1996-2010: 69 patients (14.3%) underwent AVSRR for aneurysm without significant AI (≤ 1+) Subgroup analysis for bicuspid vs tricuspid

5. End Points Incidence of aortic leaflet repair Need for reinstitution of CPB increased AI compared to preoperative Combined endpoint

6. VariableMean/Frequency n=69 Preoperative Characteristics Age (years)50 ± 16 Male62 (90%) LVEF (%)64 ± 7 EDD (mm)52 ± 6 Max Diameter (mm)51 ± 6 NYHA Class I55 (80%) II12 (17%) III2 (3%) Prior Cardiac Surgery8 (12%) Operative Characteristics Concomitant Procedure17 (25%) Cross Clamp Time (min)120 ± 41 CPB Time (min)133 ± 38

7. VariableFrequency n=69 Leaflet Reconstruction36 (52%) Second Pump Run1 (1.5%) Increased AI0 (0%) AI > 1+ at Discharge1(1.5%)

8. VariableBicuspid n=26 Tricuspid n=43 p - Value Preoperative Characteristics Age (years)48± 1451± 180.5 Male39 (91%)23 (88%)1.0 LVEF (%)63 ± 766± 90.4 EDD (mm)52 ± 452 ± 71.0 Max Diameter (mm)50 ± 851± 50.7 NYHA Class0.3 I19 (73%)36 (84%) II7 (27%)5 (12%) III0(0%)2(5%) Prior Cardiac Surgery0 (0%)8 (19%)0.02 Operative Characteristics Concomitant Procedure2 (8%)15 (35%)0.008 Cross Clamp Time (min)105 ± 30129 ± 450.01 CPB Time (min)119 ± 28142± 410.008

9. Combined End-Point P< 0.001 %

10. AI at Discharge P=0.6 %

11. Midterm Freedom from AI

12. Conclusions AVSRR performed for root aneurysm without AI can induce leaflet prolapse and AI Bicuspid aortic valves are particularly susceptible to induced prolapse and concomitant leaflet repair is very frequently required Induced prolapse in tricuspid valves is uncommon Surgeons must be prepared to perform concomitant leaflet repair during AVSRR