“Is It Possible To Have A Bicuspid Aortic Valve Repaired With A Dilated Aorta?” With Dr. S. Chris Malaisrie
I recently received a great question about bicuspid aortic valve repair. The patient wrote to me, “Adam – I have a bicuspid aortic valve and a dilated aorta. I think I need an aortic valve replacement and an aortic root replacement. I’m curious. Is it possible to get a bicuspid aortic valve repair instead of having it replaced?”
During my recent tour of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, I was fortunate to ask this exact question to Dr. S. Chris Malaisrie, a cardiac surgeon who specializes in aortic valve treatment. Here are the highlights of our discussion. (For those patients and caregivers in our community who are hearing impaired, I have provided a written transcript below.)
Thanks to Dr. Malaisrie for taking the time to meet with us and share his clinical expertise. To learn more about Dr. Malaisrie, please click here.
Keep on tickin!
P.S. Here is the transcript of the video interview with Dr. Malaisrie.
Adam: Hi everybody it’s Adam and we are coming to you from The Bluhm Cardiovascular Institute at Northwestern Memorial Hospital. We’re answering your questions that were put up at HeartValveBlog.com. I’m thrilled to be standing with Dr. S. Chris Malaisrie, who is one of the staff surgeons here. We’ve got a great question. The patient writes, “I am a fifty year old male. I have a bicuspid aortic valve and a dilated aorta. I think I need an aortic valve replacement and an aortic root replacement. but I’m curious to know, is it possible to get a bicuspid aortic valve repair instead of having it replaced?”
Dr. Chris Malaisrie: So that’s a very common scenario and we see this patient a lot in clinic here. Bicuspid aortic valve disease is actually a very common disease. About 1 to 2 percent of the population will have a bicuspid aortic valve and fifty percent of patients who need surgery on the aortic valve also have an aortic root aneurysm. So, this patient is correct, in that the standard operation for an aortic root replacement in a bicuspid aortic valve is to have the full root replaced along with the aortic valve and that is otherwise known as a Bentall procedure. (To learn more about bicuspid valves, click here.)
Now, aortic root replacement with aortic valve replacement comes along with some problems. Prosthetic valves are very good, but not perfect, so mechanical valve replacements versus bioprosthetic valve replacements have certain limitations. So, this question is actually very applicable because I think that aortic valve repair, in particular for bicuspid aortic valves is a good option. Now, the number one question we have to ask this patient is, “Is that aortic valve functional?”. Assuming that the valve is either competent, completely competent, functions well and has no aortic stenosis, this valve would be a good candidate for a valve sparing aortic root replacement. Even if the valve is a little bit leaky, we call that regurgitation, we would also be able to repair that.
Stenotic valves tend not to be good valves for preservation, so I think for this patient a valve sparing aortic root replacement, also known as a David procedure or a Yacoub procedure would be a very good option for him. I think the benefits would be avoidance of related complications and hopefully getting long term durability — at least better than a bioprosthetic valve.
Adam: Well Dr. Malaisrie, thanks for taking the time to answer our questions today and thanks for all of the great clinical work that you are doing with your patients and the ongoing research. We really appreciate your time and your effort with our community. Thanks so much!
Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.