Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease Fabian A. Kari, MD, David H. Liang, MD, PhD, John-Peder.

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Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease Fabian A. Kari, MD, David H. Liang, MD, PhD, John-Peder Escobar Kvitting, MD, PhD, Elizabeth H. Stephens, MD, PhD, R. Scott Mitchell, MD, Michael P. Fischbein, MD, PhD, D. Craig Miller, MD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages S35-S40.e2 (March 2013) DOI: 10.1016/j.jtcvs.2012.11.043 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Kaplan Meier estimate of freedom from reoperation for 75 patients with bicuspid aortic valve undergoing valve-sparing aortic root replacement. Error bars indicate ±1 standard error of the mean. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S35-S40.e2DOI: (10.1016/j.jtcvs.2012.11.043) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Preoperative, early postoperative, and late postoperative degrees of echocardiographic aortic regurgitation. See text for details of the timing of the postoperative echocardiograms. n.s., Not significant. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S35-S40.e2DOI: (10.1016/j.jtcvs.2012.11.043) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Upper images: Central free margin shortening on the fused right and left coronary cusps (Sievers' type S1/L-R configuration bicuspid aortic valve [BAV]). Left, There is minimal cusp fibrosis or calcification and aortic regurgitation (AR) is mainly caused by cusp redundancy and prolapse (El Khoury type Ib AR). Right, Correction for prolapse to optimize coaptation level and height after placement of 2 central free margin shortening sutures. Middle images, Sievers' type S1/L-R BAV before (left) and after (right) triangular resection of the raphé between the fused left and right coronary cusps. Lower images: Left, Native suspensory cord to raphé free margin between the fused right and left coronary cusps in a Sievers' type S1/L-R BAV with considerable thickening and fibrosis of raphé. Right, Valve after neosuspensory-cord-creation using polytetrafluoroethylene (PTFE) sutures to the prolapsing left-right fused cusp free margin at the raphé and central free margin shortening of the noncoronary cusp. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S35-S40.e2DOI: (10.1016/j.jtcvs.2012.11.043) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Types of cusp repair strategies performed at the time of reimplantation of the valve-sparing aortic root replacement stratified according to Sievers' types of bicuspid aortic valve configuration. FM, Cusp free margin; NC, noncoronary cusp; LC, left coronary cusp; RC, right coronary cusp. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S35-S40.e2DOI: (10.1016/j.jtcvs.2012.11.043) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions