Ulrich Schneider, MD, Susanne K

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Two decades of experience with root remodeling and valve repair for bicuspid aortic valves Ulrich Schneider, MD, Susanne K. Feldner, MD, Christopher Hofmann, Jakob Schöpe, MSc, Stefan Wagenpfeil, PhD, Christian Giebels, MD, Hans-Joachim Schäfers, MD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 4, Pages S65-S71 (April 2017) DOI: 10.1016/j.jtcvs.2016.12.030 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 CONSORT-style design describing our surgical experience with regurgitant BAVs from November 1995 to December 2015. BAV, Bicuspid aortic valve; AV, aortic valve; STJR, sinotubular junction remodeling. The Journal of Thoracic and Cardiovascular Surgery 2017 153, S65-S71DOI: (10.1016/j.jtcvs.2016.12.030) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cumulative incidence for reoperation. Red lines highlight the 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2017 153, S65-S71DOI: (10.1016/j.jtcvs.2016.12.030) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Subdistribution cumulative incidence for recurrent AR II (accounted for mortality and occurrence of AR I and AR III). Red lines highlight 95% confidence interval. AR, Aortic regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2017 153, S65-S71DOI: (10.1016/j.jtcvs.2016.12.030) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Subdistribution cumulative incidence for relevant aortic stenosis (accounted for mortality). Red lines highlight 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2017 153, S65-S71DOI: (10.1016/j.jtcvs.2016.12.030) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Cumulative incidence for reoperation Cumulative incidence for reoperation. Red lines highlight the 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2017 153, S65-S71DOI: (10.1016/j.jtcvs.2016.12.030) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 On cardiopulmonary bypass, the aorta is crossclamped and incised in a longitudinal fashion. After aortic transection, the stay sutures are placed through the commissures, aortic sinuses are excised, and coronary buttons are preserved. Subsequently, the geometric height of the nonfused cusp is measured to exclude retraction. Direct intubation with a Hegar sizer reveals an enlarged basal ring. A Dacron graft is tailored symmetrically to establish a commissural orientation of 180°. Subsequently, it is sutured to the aortic root following the insertion line of the cusps of the aortic valve. Afterward, a suture annuloplasty is placed around the enlarged basal ring and tied around a graded Hegar dilator. Measuring the effective height of the nonfused cusp reveals prolapse, which is corrected by central plication. Prolapse of the fused cusp is corrected similarly until direct comparison shows identical height. Finally, the Dacron graft is sutured to the ascending aorta. Intraoperative transesophageal echocardiography shows a competent aortic valve. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)30014-4/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, S65-S71DOI: (10.1016/j.jtcvs.2016.12.030) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions