Transthoracic echocardiogram was performed at 6 ± 3 days and at 2.9 ± 2.1 years. BAV type was documented intraoperatively, and CAC determined from pre- and postoperative computed tomography scans as the angle subtended by the non-fused cusp. We studied the impact of commissural angular configuration (CAC) and of BAV type on valve performance after V-SARR.Ī total of 85 BAV patients (68 males, age 44 ± 11 years) underwent Tirone David-V V-SARR between 19. We describe the known and hypothesized hemodynamic and hereditary factors that may result in aortic aneurysm formation in BAV patients.Ī 180/180° configuration has been reported to increase repair durability after valve-sparing aortic root replacement (V-SARR) for bicuspid aortic valve (BAV) disease. This paper reviews results of recent human and experimental studies on the significance of BAV types for local aortic media disease and location and extent of the aortopathy. The exact nature of the relation between BAV type and the aneurysm's location and extent as well as to the risk of aortic complications remains unclear. On the other hand, the aortopathy's longitudinal extent and location may represent a different pathophysiological substrate, probably dictated by the heritable aspects of BAV disease. Cusp fusion pattern, altered hemodynamics, and the qualitative severity of the disease in the aortic media might on the one hand share the same substrate. Some BAVs with raphe seem more aggressive than BAV without a raphe. However, BAV type is likely linked to the severity of aortic media disease. Data imply that the BAV type is probably not related to location and extent of the aneurysm.
Recent findings suggest that various BAV types represent different pathophysiological substrates on the aortic media level. There are numerous types of bicuspid aortic valve (BAV) configurations. The risk stratification for failure of a V-SARR, patient selection and the selection of the reconstructive techniques are today based on subjective case-by-case decisions and are not supported by robust, controlled and prospectively generated data. With respect to the clinical management of the regurgitant BAV there is a tendency towards valve reconstruction and valve-sparing aortic root replacement (V-SARR). The genetically fixed pattern of cusp fusion, hemodynamic and rheological changes as well as the local quantity and distal extent of the thoracic aortopathy are all part of a pathophysiological complex which is increasingly better understood. Some specific BAV types seem to have a more virulent and accelerated natural history than others.
The valvular configuration type and the geometry of the aortic root are not linked to the distal extent of the thoracic aortopathy, while these do correlate with the local quantity of media degeneration. Research findings suggest that various BAV types differ with respect to molecular assembly of the aortic media and cusp tissue. The bicuspid aortic valve (BAV) presents with a wide morphological variety and is associated with an increased incidence of aortic valve dysfunction, thoracic aortic aneurysms and dissections.