Cusp plication, pericardial patch augmentation
The standard surgical repair technique we applied in patients with BAV
has been described previously [5,8,9]. The asymmetry of the bicuspid
aortic root often results in a higher coaptation level of the nonfused
leaflet. We observed a higher localization of the annular attachment of
the fused leaflet in the outflow tract. To compensate the mismatch in
the coaptation level and surface of BAVs the fused leaflet was corrected
correspondingly by plication and/or pericardial patch augmentation
(Figure 1).
In detail, the free margin of the cusp was plicated by using a central
plication with a 5-0 suture (Cardionyl®, Peters
Surgical, Bobigny Cedex, France) until the free margin reached the
height of the non-prolapsing reference cusp. Additional pericardial
patch augmentation was applied to augment the fused leaflet and
overcorrect the coaptation height to increase the coaptation surface and
restore the valve’s normal geometry. We used an autologous pericardial
patch that was treated with 0.9% glutaraldehyde solution for 10 minutes
before application. The patch was then sutured to the free edge of the
fused leaflet with a running suture using a 5-0 suture
(Cardionyl®, Peters Surgical, Bobigny Cedex, France).
Afterwards, the patch was cut to a height of about 2 mm above the
corresponding cusp.
Concomitant reduction aortoplasty, ascending aorta or aortic arch
replacement were performed in patients with aortopathy or aneurysm.