Haemodynamic Early Outcomes of Sinus Plication for Bicuspid Aortic Valve Repair

Objectives: Postoperative stenosis negatively affects durability after bicuspid aortic valve (BAV) valvuloplasty. This study was performed to evaluate the haemodynamic efficacy of sinus plication (SP) to avoid stenosis after asymmetrical BAV repair. Methods: Between 2018 and 2023, 41 patients with BAV (33.3 ± 11.5 years, 40 males) with moderate-severe aortic regurgitation (AR) underwent aortic valve repair with (SP group, n = 14) or without (NSP group, n = 27) SP. SP was performed to reduce the circumference of the fused sinus and restore sinus contour symmetry. Preoperative and postoperative haemodynamic parameters were assessed at discharge and 1 year using transthoracic echocardiography. Results: No deaths occurred within 1 year after surgery in either group. AR was well controlled and adequate left ventricular reverse remodelling was observed in both the groups up to 1 year postoperatively. At 1 year, lower transvalvular peak pressure gradient (PG) and maximum transvalvular flow velocity (Vmax) were observed in the SP group (peak PG: 17.7 ± 5.5 mmHg; % change −8.8% ± 1.1%, Vmax: 1.9 ± 0.31 m/s; % change −13.1% ± 2.1%) compared with the NSP group (peak PG: 24.7 ± 9.6 mmHg; +8.8% ± 1.3%, Vmax: 2.58 ± 0.62 m/s; +9.3% ± 2.5%), while there were no clear differences in % changes of peak PG or Vmax between the groups after adjustment for covariates. Conclusions: In BAV repair, SP was potentially associated with lower peak PG and Vmax at 1 year. These findings suggest that SP may enhance haemodynamic stability in BAV repair.