Simplified determination of commissural orientation in bicuspid aortic valves. (30th August 2020)

• Record Type: Journal Article
• Authors: Froede, Lennart; Schäfers, Sebastian; Wagenpfeil, Gudrun; Raddatz, Alexander; Hoffmann, Klaus; Schäfers, Hans-Joachim
• Is Part Of: European journal of cardio-thoracic surgery. Volume 58:Number 6(2020)
• Page Start: 1153
• Page End: 1160
• Publication Date: 2020-08-30
• Subjects: Bicuspid aortic valve -- Commissural orientation -- Aortic valve repair; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa230
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract : In the past 25 years, repair of regurgitant bicuspid aortic valves (BAVs) has evolved into an increasingly practised alternative to valve replacement [1, 2]. Abstract: OBJECTIVES: In bicuspid aortic valves (BAV), commissural orientation (CO) varies between 180° and close to 120°. Postoperative CO has a strong effect on repair durability, and different repair approaches have been proposed according to CO; it is thus important for aortic repair. A precise, simple and reproducible determination by preoperative echocardiography would facilitate intraoperative decision-making. We compared 4 different methods of determination of CO in BAV. METHODS: Preoperative transoesophageal echocardiograms of 62 patients with BAV were analysed. CO was measured using either the coaptation centre or the geometric centre of the root. The geometric centre of the root was determined through approximation using a circle or an ellipse, or the midpoint of a line between the centre of the non-fused and the fused sinuses. RESULTS: The 3 different geometric methods led to almost identical results (interclass coefficient 0.98–0.99), with the line segment being the easiest to use. The use of the coaptation centre was associated with the underestimation of commissural angle of up to 30° compared to the geometric centre; the discrepancy was significant and most pronounced for asymmetric BAV (140–160°; P = 0.005). CONCLUSIONS: CO can reproducibly be determined using a line segment between the centre of the non-fused and fused sinuses. The use of the coaptation centre can lead to misleading results, in particular in asymmetric BAVs.