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.