1. Khalil Fattouch, Roberta Sampognaro, Giuseppe Speziale, Marco Caruso, Pietro Dioguardi, Salvatore Novo, Giovanni Ruvolo. Disclosures: None Disclosures: None Aortic Symposium 2010 Sheraton Hotel and Towers, New York, USA. Results of aortic valve repair according to valve morphology and surgical techniques.

2. Background In the last decade, results of aortic valve repair were dramaticaly improved in term of mortality and freedom from aortic valve regurgitation and reoperation Several techniques were used for aortic valve repair in bicuspid and tricuspid aortic valve.

3. Study endpoints To assess postoperative outcome of aortic valve repair according to: 1. Valve morphology (tricuspid or bicuspid) 2. Surgical techniques: plication, free edge reinforcement with Gore-Tex, “chordae technique” (described by us)

4. Study Endpoints Evaluate the impact of AV repair on 6-year freedom: from overall and cardiac-related death from reoperation on aortic valve from reccurrent aortic valve regurgitation grade ≥ II Valve-related events were as follows: reccurent AR, reoperation, endocarditis, stenosis, trombo- embolism.

5. Patients and Methods Since February 2003, 216 patients with aortic regurgitation underwent valve repair in our institution. Patients were classified preoperatively according to functional classification: Type I in 55 pts (25.5%), Type II in 126 (58.3%) and Type III in 35 (16.2%). 66 pts (27.7%) had bicuspid valve

6. VariablesN° of patients (%) Age (years) Male gender Diabetes COPD Hypertension Creatinine > 1.5 Angina Atrial fibrillation 58  12 166 (76.8%) 22 (10%) 21 (9.7%) 101 (46.7%) 11 (5%) 6 (2.7%) 12(5.5%) Bicuspid 66 (27.7%) NYHA class II III IV 125(57.8%) 36 (16.5%) 24(11%) Patients Baseline Characteristics

7. VariablesN° of patients (%) Ascending Aortic Pathology: Anulo-aortic ectasia Aneurysm Marfan 55 (25.4%) 111 (51.3%) 36(16.6%) Type of Aortic regurgitation: Type I Type II Type III 55 (25.5%) 126 (58.3%) 35 (16.2%) Grade of AR: II III IV 28(13%) 30 (13.8%) 158 (73%) Patients Baseline Characteristics

8. Intraoperative Characteristics VariablesN° of Patients Valve repair methods: Sub-commissural plasty Plication Free edge reinforcement with Gore-Tex Chordae technique 138 (63.8%) 84 (38.8%) 80 (37%) 52(37.5%) Associated surgical procedures: CABG Aortic valve-sparing root replacement Ascending aortic resection Mitral valve repair 22 (10%) 78 (36%) 69 (32%) 12 (5.5%) Bypass time (min) Cross-clamp time (min) Logistic EuroSCORE Early Mortality 121  46 87  32 5.2  3.1 6 (2.7%)

9. Overall survival rate Percentage of Survival (%) years Overall survival rate was 91.5%

10. Freedom from reoperation and from recurrence of AR ≥ grade II years Freedom from reoperation was 94.8% Freedom from AR grade ≥ II was 85.5%

11. Freedom from valve-related events for bicuspid vs tricuspid years Freedom from valve related events (%)

12. Freedom from valve-related events for bicuspid vs tricuspid years Freedom from valve related events (%) (p<0.01)

13. Type I Type II Type III (p<0.001) Percentage of Survival (%) years Freedom from valve-related events according to functional classification of AR to functional classification of AR

14. Plication Free edge reinforcement with GoreTex (p<0.01) The chordae technique Percentage of Survival (%) years Freedom from valve-related events according to surgical techniques to surgical techniques

15. Conclusions Aortic valve repair can be performed  with low early (2.7%) and late mortality.  Late survival rate was 91.5% and late cardiac related death was 6%.  Overall 6-year aortic regurgitation recurrence (grade≥2) was 14.5%  Overall incidence of aortic valve reoperation after valve repair was 5.2%.

16. Conclusions  Optimal results was observed for tricuspid and pliable bicuspid valve  Optimal results was observed for Type I and II.  Better results for plicatio and The chordae technique respect to only free edge reinforcement