Bicuspid aortic root pathology is accompanied by valve leaflet abnormality that requires repair during valve sparing root replacement (VSRR). Valve stability following VSRR, were compared between tricuspid aortic (T) and bicuspid (B) aortic valves using clinical and echocardiographic examination.

From January 2003 to February 2018, 140consecutive patients (37 B and 103T) underwent VSRR surgery. Mean age was 48.5years in B and 59.1years in T. All B presented NYHA functional class I or II versus 88% of T. B presented with aortic regurgitation (AR) grade III or IV in 38% versus 58% of T (P=0,001). B had presented grade III or IV aortic regurgitation (AR) in 38% versus 58% of T. Mean left ventricular ejection fraction (LVEF) was 62%±8 for B versus 61%±9 for T (P=NS). Leaflet repair was performed in all B versus 73% of T. Other procedures were performed in 18% for T and nil for B. Patients were yearly followed by referent cardiologists. The follow-up was 96% complete with an average mean duration of 5 years (range: 6months–14.3years).

In-hospital mortality was nil in B and 2% in T. On mid-term, there were no clinical and echocardiographic differences in the two groups: all B and T presented NYHA class 1 or 2, mean LVEF was 65% in B and 60% in T; no patient in both groups presented AR>Grade 2 and mean gradient median was 9 and 4mm Hg respectively for B and T. There were 14late deaths (10%) including 2 B (stroke 1, drowning 1) and 12T (cardiac 5, Cancer 5, Trauma 1 and unknown in 1). Four T were re-operated: Bentall 2, transcatheter Aortic Valve Implantation 1 and mitral valve repair 1. Late major complications were reported in four patients.

VSRR ensures excellent mid-term aortic valve function independently of its morphology. In B associated with aortic root aneurysm, leaflet repair does not increase the valve-related events.