The Effectiveness of Aortic Valve Repair in Multiple Valve Phenotypes Assessed by Advanced Imaging Studies

P0332 

Abstract Submission 

John Eisenga (1), Zuyue Wang (2), Kyle McCullough (3), Ghadi Moubarak (4), Tsung-Wei Ma (1), Ambarish Gopal (5), J. Michael DiMaio (6), William Brinkman (7), Amro Alsaid (2)

(1) Baylor Scott & White Research Institute, Plano, TX, (2) Baylor Scott & White - The Heart Hospital, Plano, TX, (3) Baylor Scott and White Research Institute, Plano, TX, (4) N/A, N/A, (5) Baylor Scott & White Health - The Heart Hospital, Plano, TX, (6) The Heart Hospital Baylor Plano, Dallas, TX, (7) Baylor Scott & White Health, TX

John Eisenga    -  Contact Me
Baylor Scott & White Research Institute

Zuyue Wang    -  Contact Me
Baylor Scott & White - The Heart Hospital

Kyle McCullough    -  Contact Me
Baylor Scott and White Research Institute

Ghadi Moubarak    -  Contact Me
N/A

Tsung-Wei Ma    -  Contact Me
Baylor Scott & White Research Institute

Ambarish Gopal    -  Contact Me
Baylor Scott & White Health - The Heart Hospital

*J. Michael DiMaio    -  Contact Me
The Heart Hospital Baylor Plano

*William Brinkman    -  Contact Me
Baylor Scott & White Health

Amro Alsaid    -  Contact Me
Baylor Scott & White - The Heart Hospital

John Eisenga    -  Contact Me
Baylor Scott & White Research Institute

Objective: We used advanced cardiac imaging studies to evaluate the effectiveness of aortic valve (AV) repair in tricuspid aortic valves and multiple de Kerchove bicuspid aortic valve phenotypes.

Methods: This is a prospective trial assessing the effectiveness of AV repair using advanced cardiac imaging studies. Patients underwent pre- and postoperative echocardiogram and CTA which were reviewed by specialized cardiac imaging cardiologists. For descriptive analyses, frequencies and percentages are used to present categorical variables. Median and Interquartile ranges are used to describe continuous variables with non-normal distribution, while mean and standard deviation are used to present normally distributed variables. Chi-square test, Fisher's exact test, Kruskal-Wallis test, and two-sample t-test were used as indicated. Statistical significance was determined as p<0.05.

Results: 22 patients underwent aortic valve repair surgery in this study. 20/22 (90.9%) patients were male, and the median age was 52 [47-58] years. 16 patients had a preoperative diagnosis of an aortic aneurysm. Zero patients had previous valve intervention. There were nine patients with tricuspid aortic valves (TAV) and 13 patients with bicuspid aortic valves. Of the bicuspid valves: 5 were type A (BAV-A), 5 were type B (BAV-B), and 3 were type C (BAV-C). Preoperative echocardiogram noted aortic insufficiency (AI) >1+ in 7/8 TAV, 4/5 in BAV-A, 5/5 in BAV-B, and 3/3 in BAV-C. Preoperative median mean and peak gradients were 4/6, 6/13, 6.2/11, and 5.5/10.5 in the groups respectively. Preoperative and postoperative CTA measurements of non-coronary cusp geometric, commissural, coaptation and effective heights are reported in the table below. Post-operative echocardiogram noted AI >1+ in 0/7 TAV, 0/5 in BAV-A, 0/5 in BAV-B, and 0/3 in BAV-C. Postoperative mean and peak AV gradients were 3.8/6.5, 6.5/12, 5.5/9, and 8/15 in the groups respectively.

Conclusion: Valve repair surgery in aortic insufficiency can be accomplished with satisfactory results in multiple phenotypes of AV. Our experience demonstrates resolution of AI in all patients in our series. However there appeared to be a non-significant trend for increased valve gradients in BAV-C patients, continued surveillance is ongoing.

Aortic Root