Video: “Does A Bicuspid Aortic Valve Become Tricuspid During Heart Valve Repair Surgery?” Asks Sato
By Adam Pick on September 22, 2011
Sato sent me a very interesting question about bicuspid aortic valve repair. He writes, “Hi Adam – I’m 61. I’ve been diagnosed with bicuspid aortic valve and severe regurgitation. I’ve been told a repair is possible. During surgery, does the bicuspid aortic valve become a tricuspid valve?”
While at the American Association of Thoracic Surgeons conference, I was able to ask Sato’s question to Dr. Lars Svensson, MD, the Director of the Aorta Program at The Cleveland Clinic. As you may know, Dr. Svensson, is highly regarded for his work with bicuspid aortic valves.
Thanks to Sato for his question and a special thanks to Dr. Lars Svensson for sharing his clinical research with our community. To learn more about Dr. Svensson and his patients, please click here.
For those of you who are hearing impaired, I have provided a transcript of this interview below…
Adam: Hi everybody its Adam and we’re coming to you from the AATS in Philadelphia. Very excited to be standing next to Dr. Boris Svennson. He’s director of the Aortic program at the Cleveland Clinic. We’ve got a question that comes in today from Sato. I’m 61 and diagnosed with bicuspid aortic valve with severe regurgitation. The doctors tell me repair is quite possible but is it possible to repair a bicuspid aortic valve to a tricuspid aortic valve?
Dr. Svennson: That’s an interesting question because it does come up quite often. Basically the problem is you cannot take a bicuspid valve and make it into a three, tricuspid valve because there’s no support for the conjoined leaflet. Probably 70% of the patients we see there’s a cleft in the two leaflet fuse section so it’s better and easier to make it into a two leaflet valve, a true bicuspid aortic valve so we sew up the little gap between the two edges where there’s a missing piece in a sense and then we make it symmetrical and then it works out very well. (To learn more about bicuspid aortic valves, click here.)
If you go to our Cleveland Clinic website there’s actually a little video clip of how we do that. That results in a very high success rate. We’ve got a paper that’s going to be coming out now in the Journal of Thoracic and Cardiovascular Surgery looking at the long term benefits of repair versus replacement in young patients.
- I think the average age was 53 and if you follow patients out over time, after seven years there’s a survival benefit to having your repair done, for bicuspid valve or tricuspid valve and then if you go out to about nine or ten years, the failure rate is also significantly lower with the repair than compared to a biological heart valve replacement.
- In those initial first years, the difference for a tricuspid repair vs. a biological valve is only about 2.5% and then when you get out to ten years the durability of the repair is about 94% for a tricuspid valve.
- So not only with a repair are you less likely to have a stroke and infect the valves but you also have a survival advantage that our data shows about seven years after having valve repair and you also have a lower risk of heart valve reoperation after about ten years.
We’re very happy to see that we can do something for suitable patients who are young, particularly with aortic valve repair, or aortic valve regurgitation.
Adam: Dr. Svennson as always thank you for taking the time to come and meet with us and share your information and research, all the clinical work that you’ve been doing. I know you’ve been doing this for over 30 years now and I just want to thank you for everything your doing on behalf of all the patients that are out there.
Keep on tickin!