Bicuspid Aortic Valve Repair: 15-Year Outcomes with Dr. Ismail El-Hamamsy

For decades, the primary treatment for symptomatic bicuspid aortic valve disease has been surgical aortic valve replacement with either a mechanical or tissue valve, or the Ross Procedure. More recently, transcatheter aortic valve replacement has also emerged as a viable option. Over the past 20 years, researchers and surgeons have developed techniques for BAV repair, believing that keeping one's own tissue may offer better overall outcomes than a replacement valve.

To learn more about the latest research and surgical outcomes on this topic, we spoke with Dr. Ismail El-Hamamsy about an oral abstract presentation on BAV repair that he would be giving at the American Association for Thoracic Surgery Annual Meeting. Dr. El-Hamamsy is the Director of Aortic Valve Surgery at Mount Sinai Health in New York. He is widely acknowledged as one of the world’s best aortic surgeons and a distinguished researcher with more than 200 published scientific papers in several prominent peer-reviewed journals.

Video available online at:

https://www.youtube.com/watch?v=LXD6FiRGB8E

Facts About the 15-Year Outcomes of BAV Repair Surgery

Here are the key insights shared by Dr. El-Hamamsy:

• The explanation of the abstract and subject presentation. Dr. El-Hamamsy explained, “An abstract is essentially a study that we present in an oral format in front of all the attendees. We’re here at the AATS, which is the main cardiac surgery conference in our field. We’re looking at a study in which we analyzed the long-term outcomes of patients with leaking bicuspid valves who had their valves repaired rather than replaced. This is very novel because most centers or surgeons will typically default to replacing bicuspid valves or leaky bicuspid valves.”

• Bicuspid valve repair versus mitral valve repair. “About 20 years ago or so, we started to get interested in the concept of repairing aortic valves, very much like we do with mitral valves,” said Dr. El-Hamamsy. “And we know that when we repair a mitral valve, we can restore the patient’s survival, quality of life, and exercise capacity in the long term. Our question was, ‘Can we do the same on the aortic side?’”

• Surgical repair approaches and outcomes over 15 years. “The techniques evolved and improved, and there was a clear understanding of the mechanisms of why these valves leak, and the patient selection got better. The data we’re presenting today analyzes the 15-year outcomes of patients who underwent bicuspid valve repair. I’m very happy to report that in patients who qualify for a repair of their bicuspid valve, the results up to 15 years are very good in two ways. First, their survival is identical to that of the general population, matched for age and sex. Second, valve function is well preserved during the first 15 years after bicuspid valve repair.”

• The knowledge gained over 15 years. “We’ve also learned it’s a technical operation, and there is a learning curve,” said Dr. El-Hamamsy. “Our early results are not quite the same as our later results. The technical principles are now very clearly defined, and our selection of which patients should have a repair and which should not is also much more refined than it used to be.”

• The working criterion decision about repair or replacement. “I always tell patients that when we have young people with bicuspid valves that have regurgitation, we’re going to repair them if we meet two conditions, which are if it is doable, and equally importantly, if we think it will be durable. Doable and durable.” Dr. El-Hamamsy added that most valves can be repaired, but not all repairs will last long enough to justify repair over replacement.

Thanks Dr. El-Hamamsy and Mount Sinai Health!

On behalf of all the patients in our community, thank you, Dr. Ismail El-Hamamsy, for everything you and your team are doing at Mount Sinai Health in New York City!

Related links:

• See Dr. Ismail El-Hamamsy's Interactive Surgeon Profile with 50+ Patient Reviews

• Surgeon Q&A with Dr. Ismail El-Hamamsy: Ross Procedure Survival Advantages for Aortic Valve Disease

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. El-Hamamsy below.