Study population and follow-up
A retrospective review of our Institutional, prospectively maintained,
database was carried out to identify patients with BAV and mild to
moderate aortic regurgitation who underwent elective ascending aorta
replacement from June 2002 to January 2020. Patients with acute aortic
dissections and aortic root pathology were excluded. Bicuspid aortic
valve morphology was preoperatively characterized by means of
trans-thoracic or trans-esophageal echocardiography and subsequently
intraoperatively confirmed. Patients charts were then analyzed to obtain
details about pre-operative characteristics, intra-operative variables
and in-hospital outcomes. All operations were performed using
conventional cardio-pulmonary by-pass and mild hypothermia through a
median sternotomy. The final decision to preserve the BAV was taken
intraoperatively by the operating surgeon according to the degeneration
degree of the aortic leaflets. Usually the native BAV was preserved
because the leaflets appeared relatively free from fibrosis or
calcification. The size of the aortic vascular graft, and the subsequent
degree of sino-tubular junction (STJ) remodeling, was decided by the
operating surgeon according to the anatomical finding. In case of
moderate aortic regurgitation, type Ia according to the El-Khoury
classification8, a smaller graft was employed to
restore a more physiological annulus/STJ ratio and decrease the grade of
aortic regurgitation. Transesophageal echocardiography was performed
after weaning from the CPB to assess the BAV function. Survival and
echocardiographic follow-up were carried on querying the informatic
hospital system for out-patients visit and echocardiographic
examinations. If follow up information were not present in the hospital
system, patients were reached via phone call or the referring
cardiologist was contacted. The Ethical Committee of our Institution
approved the study and individual informed consent for this
retrospective analysis was not requested.