Isolated bicuspid aortic valve repair: Experience over two decades

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Domínguez del Castillo, Ignacio Muñoz Carvajal" "autores" => array:2 [ 0 => array:2 [ "nombre" => "José J." 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HAART™ – Heart Aortic Valve Annulus Remodeling Technique, VAJ – venticulo-aortic junction, EII – EuroSCORE II." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marek J. Jasinski" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Marek J." "apellidos" => "Jasinski" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134009622001541?idApp=UINPBA00004N" "url" => "/11340096/00000030000000S1/v1_202308100556/S1134009622001541/v1_202308100556/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Isolated bicuspid aortic valve repair: Experience over two decades" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S5" "paginaFinal" => "S10" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Tristan Ehrlich, Karen B. Abeln, Lennart Froede, Flora Schmitt, Christian Burgard, Hans-Joachim Schäfers" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Tristan" "apellidos" => "Ehrlich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Karen B." "apellidos" => "Abeln" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] 2 => array:2 [ "nombre" => "Lennart" "apellidos" => "Froede" ] 3 => array:2 [ "nombre" => "Flora" "apellidos" => "Schmitt" ] 4 => array:2 [ "nombre" => "Christian" "apellidos" => "Burgard" ] 5 => array:4 [ "nombre" => "Hans-Joachim" "apellidos" => "Schäfers" "email" => array:1 [ 0 => "h-j.schaefers@uks.eu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reparación aislada de la válvula aórtica bicúspide: experiencia de más de dos décadas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1417 "Ancho" => 2500 "Tamanyo" => 177694 ] ] "descripcion" => array:1 [ "en" => "Survival with and without annuloplasty (p<.0001)." ] ] ] "textoCompleto" => "IntroductionThe bicuspid aortic valve (BAV) is the most frequent congenital cardiac anomaly.<a class="elsevierStyleCrossRef" href="#bib0105">1</a> It is characterized by partial or complete fusion between two cusps and the presence of a nonfused cusp. Prolapse of the fused cusp and annular dilatation are the most common intraoperative findings.<a class="elsevierStyleCrossRef" href="#bib0110">2</a> Patients with a bicuspid aortic valve frequently require surgical intervention for aortic regurgitation (AR) and/or aneurysm at a young age.<a class="elsevierStyleCrossRef" href="#bib0115">3</a>Preservation or repair of the aortic valve has evolved in the past 20 years. First attempts were made at treating isolated aortic regurgitation by repair.<a class="elsevierStyleCrossRefs" href="#bib0120">4,5</a> Also operations were developed to treat patients with aortic root aneurysm and presumably normal cusps.<a class="elsevierStyleCrossRefs" href="#bib0130">6,7</a> With increasing knowledge of the anatomy of the aortic valve and repair options, both procedures have progressed in the past 20 years.<a class="elsevierStyleCrossRef" href="#bib0140">8</a> Repair leads to a high freedom from valve-related complications and good survival if an adequate valve durability can be achieved.<a class="elsevierStyleCrossRefs" href="#bib0140">8,9</a>In the meantime, aortic valve repair has become a routine procedure in experienced centers, and most BAVs can be preserved or repaired.<a class="elsevierStyleCrossRef" href="#bib0150">10</a> Anatomic characteristics of the valves have been defined that require to be addressed, such as commissural orientation, annular dilatation or prolapse.<a class="elsevierStyleCrossRef" href="#bib0155">11</a> Thus, rather than improvising the operation, repair has changed into a systematic approach with clear identification and subsequent correction of the mechanisms leading to regurgitation. In particular, using the concepts of effective height<a class="elsevierStyleCrossRef" href="#bib0160">12</a> and geometric height,<a class="elsevierStyleCrossRef" href="#bib0165">13</a> excellent repair durability and freedom from valve-related complications have been achieved.<a class="elsevierStyleCrossRefs" href="#bib0140">8,9</a> Creation of symmetric commissural orientation has improved repair durability further. In addition, we introduced a suture annuloplasty to correct annular dilatation with good midterm results.<a class="elsevierStyleCrossRef" href="#bib0170">14</a>During the past 20 years, we have consistently applied this differentiated anatomic concept in the repair of BAVs. With follow-up reaching more than 20 years, we now intend to analyze the long-term durability of isolated BAV repair.MethodsPatient populationBetween October 1998 and December 2020, 547 patients with a bicuspid aortic valve underwent isolated repair for AR in our institution. These patients were the subject of this study. The investigation was approved by the respective ethics committee (Saarland Regional Ethics Committee, CEP 202/19), and individual patient consent was waived for the analysis and publication in anonymized fashion.The patient age ranged from 5 to 79 years (mean 41.9±13.4 years). Most of the patients were male (n=507; 92.7%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Preoperative AR was relevant (III° or IV°) in most patients (n=516; 94.33%). The left ventricular end-diastolic diameter ranged from 37 to 84mm (mean 63.73±7.4). The mean sinus diameter was 36.2±4.2mm, and the mean annulus diameter was 30.1±3.5.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Cusp fusion was mostly seen between the right and the left coronary cusp (n=462; 84.5%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The commissural orientation of the nonfused cusp varied with predominant orientation of 160° or more (n=353; 64.5%). An asymmetric orientation (140–155°) was present in 160 patients (29.3%) and a very asymmetric orientation (<140°) was observed in 51 individuals (9.3%). Limited cusp calcification was present in 47 individuals (8.6%), in most instances in the raphe.Surgical techniqueThe chest was opened via median sternotomy, and aorta and right atrium were cannulated. The aorta was opened via transverse incision 5–10mm above the sinotubular junction, and blood cardioplegia was given directly into the coronary ostia. The circumferential orientation was determined and maintained using stay sutures placed into the commissures and fixed to the chest wall of the patient. Valve assessment included measurement of both geometric and effective height, the diameter of the basal ring was evaluated by direct intubation using a Hegar dilator.Repair was performed if the geometric height of the nonfused cusp exceeded 20mm in order to rule out relevant retraction, otherwise valve replacement was performed. Prolapse was defined as an effective height less than 9mm in the nonfused cusp. In the fused cusp, prolapse was determined by visual comparison of the height of the free cusp margin relative to the nonfused cusp.Prolapse of the fused cusp was corrected by plication of the central free margin. A triangular resection was performed if extreme tissue redundancy, dense fibrosis, or limited calcification made direct tissue adaptation difficult or impossible. In case of more extensive calcification, a patch of autologous pericardium was inserted. The patch was trimmed and inserted into the tissue defect of the fused cusp using continuous polypropylene suture (Prolene 5-0,Ehicon, Hamburg, Germany).A suture annuloplasty was added to reduce dilatation of the basal ring if it was larger than 26mm. In the first 39 patients, a braided polyester suture was used, in the remaining 361 individuals an expanded polytetrafluorethylene (PTFE) was employed (Gore-Tex CV-0; WL Gore and Associates, Munich, Germany). As described previously (), the annuloplasty suture was either tied around a 21mm, 23mm, or 25mm Hegar dilator according to body surface area (less than versus greater than or equal to 2m2).Follow-upAll patients were seen regularly by referring cardiologists or the institutional clinic. Echocardiograms or their reports from both institutions and patients’ cardiologists were reviewed.<a class="elsevierStyleCrossRef" href="#bib0175">15</a> In addition, the patients were contacted via phone or seen in clinic to determine current functional status. The cause of death was determined by review of hospital charts or information was sought from respective primary care physicians.Follow up was 92% complete (3341 patient-years) with a mean follow-up of 73.3±56 months (median 59.9 months). The first time of AI≥2 was recorded for a time-to-event analysis.Statistical analysisContinuous data are expressed as mean±standard deviation. Data taken from the Kaplan–Meier curve are expressed as mean±standard error. A p value<0.05 was considered statistically significant. Differences between continuous variables were compared by Student's t-test or by Mann–Whitney U test in case of inhomogeneous variances. Categorical data were compared using chi-square test. All data were analyzed using statistical package SPSS version 28 (SPSS Inc., Chicago, IL, USA). In logistic regression analysis, a p value less than 0.10 in the univariable analysis was defined for entry into the multivariable analysis. We applied a stepwise procedure for selecting variables based on the Wald criterion of forward induction. We ended up with the following results.ResultsConcomitant procedures were performed in 59 patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>); these included coronary artery bypass grafting (n=12), mitral repair (n=31), tricuspid valve repair (n=12), and left atrial ablation (n=18). Plication of the fused cusp was performed in 422 instances (77.1%).The duration of myocardial ischemia ranged from 12 to 118min (mean 32±13min). The mean time of extracorporeal circulation time was 49.7±18.7min. Reexploration for hemorrhage was necessary in 7 patients (1.3%). Three patients (0.55%) required pacemaker implantation for postoperative atrioventricular block were necessary.SurvivalOne patient died early for an in-hospital mortality of 0.18%. The patient underwent surgery for active endocarditis and suffered a perioperative stroke with intracerebral hemorrhage.Over time, 12 patients (2.2%) died between 2 and 157 months postoperatively. Survival was 98.2%±0.7 at 5 years, 96.9%±1 at 10 years, and 93.2%±2.7 at 15 and 20 years. With the addition of suture annuloplasty, survival was 99.7%±0.3 at 10 years; it was 91.4%±2.7 without annuloplasty (p<.0001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No fatal outcome was directly or indirectly related to inadequate function of the repaired aortic valve.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>By logistic regression, lack of an annuloplasty (p=0.003; OR 23) and presence of limited valve calcification (p=0.027; OR 4.1) were independent predictors of death.ReoperationForty-eight patient (8.8%) required a reoperation on the aortic valve between 1 and 147 months postoperatively. Freedom from reoperation was 92.2%±1.3 at 5 years, 86.5%±2.2 at 10, and 83.7±2.9 at 15 and 20 years respectively (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). With the addition of suture annuloplasty, freedom from reoperation was 97.5%±0.9 at 10 years; it was 67.4±4.6 without annuloplasty (p<.0001) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>By separate logistic regression analysis, the use of pericardial patches (p=0.019; OR 2.6), subcommissural plication (p<.0001; OR 7.3) and the lack of an annuloplasty (p<.0001; OR 17) were independent predictors for reoperation.Freedom from AI≥IIThere was a high proportion of competent aortic valves or only trivial regurgitation at the times of discharge (AI≤I; 98.5%). The proportion of functionally competent aortic valves at discharge was higher with the use of annuloplasty (AI≤I; 99% vs 91%; p<.001).Valve function remained constant in the majority of patients, while some developed recurrent regurgitation. Freedom from AI≥II was 90.2%±1.4 at 5, 83.5%±2.3 at 10 and 77.7%±3.4 at 15 years. The Kaplan–Meier analysis showed a significant effect of suture annuloplasty in freedom from recurrent AI≥II at 10 years (with 90.4%±2.6; without 68%±4.4; p<.0001) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Independent predictors for recurrent AI≥II were the use of subcommissural plication (p≤.0001; OR 2.8), the use of pericardial patches (p≤.0001; OR 5.6), and the presence of cusp calcification (p=0.005; OR 3.9).DiscussionWith the development of heart valve prostheses in the 1960s, aortic valve replacement became the standard treatment for aortic regurgitation. Long-term studies, however, showed valve-related complications in a relevant proportion of patients.<a class="elsevierStyleCrossRefs" href="#bib0180">16,17</a> In addition, a non-negligible rate of valve-related mortality was observed, which was associated with reduced life expectancy after aortic valve replacement.<a class="elsevierStyleCrossRef" href="#bib0190">18</a> In addition, the risk of reoperation persisted, even after mechanical valve replacement.<a class="elsevierStyleCrossRef" href="#bib0185">17</a> Another pitfall of mechanical valves is the lifelong need of anticoagulation, with its associated risks.<a class="elsevierStyleCrossRefs" href="#bib0180">16,17</a>By contrast, aortic valve repair has been shown to largely eliminate these risks if good repair durability was achieved. With repair, survival equivalent to that of the age- and gender-matched general population, and excellent quality of life.<a class="elsevierStyleCrossRef" href="#bib0140">8</a>Repair of regurgitant bicuspid aortic valves has been performed for more than two decades. Initially, surgeons relied on a visual assessment of the cusps. Although early results were good, mid-term studies showed a relevant attrition of valve function. Based on the analysis of valve failures, we proposed the concept of effective height as a quantitative indicator of valve configuration.<a class="elsevierStyleCrossRef" href="#bib0160">12</a> Others have confirmed the benefit of this concept.<a class="elsevierStyleCrossRef" href="#bib0195">19</a> Further analysis of repair failure identified annular dilatation as an important predictor. Since the introduction of the suture annuloplasty concept, the durability of isolated bicuspid aortic valve repair could be drastically improved.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> This observation is confirmed by our current analysis. We have now been able to find a positive association between annuloplasty and not only freedom from recurrent aortic regurgitation, but also survival.Local complications associated with suture annuloplasty were almost exclusively seen early in the experience and with the use of braided polyester sutures.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> The complications have been largely eliminated by using expanded polytetrafluorethylene instead. Interference with the circumflex artery was in only few instances and could be treated by removal of the suture. Thus, our current results of aortic valve repair show a stability that is at least comparable if not superior to that described by others applying an external annuloplasty ring.Our initial enthusiasm about the excision of calcium and partial cusp replacement using pericardium has faded with the recognition of a high incidence of reoperations in the first years.<a class="elsevierStyleCrossRef" href="#bib0200">20</a> Resection of limited plaques with direct approximation of cusp tissue still seems to be an acceptable approach. We have abandoned the use of pericardium for cusp repair and now propose replacement in these instances. A caveat remains with cusp calcium being a predictor of reduced survival in our current analysis. It is unclear whether this is due to preserving suboptimal valves, or whether this is merely an indicator of a patient-specific tendency to develop atherosclerosis at an earlier age.Our current data confirm the applicability and stability of the anatomy-based repair strategy with good repair durability. Using this concept, we are now able to achieve stable repair results for the majority of patients.LimitationsThe present study has limitations owing to its retrospective and monocentric design. It includes modifications introduced over time, nevertheless, surgical bias is limited by the fact that one surgeon substantially participated in all procedures. Moreover, our findings need to be interpreted with caution owing to multiple testing and the size of different subgroups. Despite the adjustment for possible confounders, residual confounding may have been present.Nonetheless, to our knowledge, this is the first study on isolated bicuspid valve repair incorporating a population of more than 500 participants with a follow-up exceeding 20 years.ConclusionIsolated bicuspid aortic valve repair is associated with excellent survival, and the majority of BAV repairs will remain stable over more than 10 years. The use of an annuloplasty improves repair durability and is associated with improved survival. Cusp calcification and cusp repair using a pericardial patch are predictors for early valve failure.Patient and public involvementPatients were not involved in the research process of this study.Sources of fundingNone.Conflict of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1947113" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1676954" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1947114" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1676953" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical technique" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Follow-up" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Survival" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Reoperation" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Freedom from AI ≥ II" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Patient and public involvement" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Sources of funding" ] 12 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interest" ] 13 => array:2 [ "identificador" => "xack682462" "titulo" => "Acknowledgments" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-02-15" "fechaAceptado" => "2022-02-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1676954" "palabras" => array:3 [ 0 => "Bicuspid aortic valve" 1 => "Aortic regurgitation" 2 => "Aortic valve repair" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1676953" "palabras" => array:3 [ 0 => "Válvula aórtica bicúspide" 1 => "Regurgitación – insuficiencia aórtica" 2 => "Reparación de la válvula aórtica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundRepair of the bicuspid aortic valve has evolved in the past 20 years. The aim of this study was to review two decades of experience and analyze the long-term stability of BAV repair. MethodsBetween 10/1998 and 12/2020, 547 adult patients (92% male; 41.9±13.4 years) underwent a bicuspid aortic valve repair with (n=400) or without (n=147) annuloplasty. Sinus plication was performed in 175 instances (32%). Mean follow-up of 73.3±56 months (median 59.9 months); it was 92% complete. Survival and freedom from reoperation were calculated. ResultsSurvival at 20 years was 93.2%±2.7, freedom from reoperation at 20 years was 83.7±2.9. Freedom from AI≥II was 77.7%±3.4 at 15 years. By logistic regression analysis, the use of pericardial patches for cusp repair (p=0.019; OR 2.6), the use of subcommissural plication (p<.0001; OR 7.3), and the lack of annuloplasty (p<.0001; OR 17) were independent predictors for reoperation. ConclusionIsolated bicuspid aortic valve repair is associated with excellent survival, and the majority of BAV repairs will remain stable over more than 10 years. The use of an annuloplasty improves repair durability and patient survival. Cusp calcification and cusp repair using a pericardial patch are predictors for early valve failure." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa reparación de la válvula aórtica bicúspide ha evolucionado en los últimos 20 años. El objetivo de este estudio fue revisar nuestra experiencia de dos décadas y analizar la estabilidad a largo plazo de la reparación de BAV. MétodosEntre octubre de 1998 y diciembre de 2020, 547 pacientes adultos (92% varones; 41,9 ± 13,4 años) se sometieron a una reparación de la válvula aórtica bicúspide con (n = 400) o sin (n = 147) anuloplastia. La plicatura de senos se realizó en 175 casos (32%). Seguimiento medio de 73,3 ± 56 meses (mediana 59,9 meses); fue completado en un 92%. Se calculó la supervivencia y la ausencia de reoperación. ResultadosLa sobrevida a los 20 años fue de 93,2% ± 2,7, la ausencia de reoperación a los 20 años fue de 83,7 ± 2,9. La ausencia de IA ≥ II fue del 77,7% ± 3,4 a los 15 años. Mediante análisis de regresión logística, el uso de parches pericárdicos para la reparación de las cúspides (p = 0,019; OR 2.6), el uso de la plicatura subcomisural (p < 0,0001; OR 7,3), y la falta de anuloplastia (p < 0,0001; OR 17) fueron predictores independientes para la reoperación. ConclusiónLa reparación aislada de la válvula aórtica bicúspide se asocia con una excelente supervivencia, y la mayoría de las reparaciones de BAV se mantendrán estables durante más de 10 años. El uso de una anuloplastia mejora la durabilidad de la reparación y la supervivencia del paciente. La calcificación de la cúspide y la reparación de la cúspide con un parche pericárdico son predictores de la falla temprana de la válvula." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "These authors contributed equally to this work." "identificador" => "fn0005" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1417 "Ancho" => 2500 "Tamanyo" => 177694 ] ] "descripcion" => array:1 [ "en" => "Survival with and without annuloplasty (p<.0001)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1403 "Ancho" => 2500 "Tamanyo" => 145502 ] ] "descripcion" => array:1 [ "en" => "Freedom from reoperation after repair of regurgitant bicuspid aortic valves." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1415 "Ancho" => 2500 "Tamanyo" => 188297 ] ] "descripcion" => array:1 [ "en" => "Freedom from reoperation with and without annuloplasty (p<.0001)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1416 "Ancho" => 2500 "Tamanyo" => 183298 ] ] "descripcion" => array:1 [ "en" => "Freedom from AI≥II with and without annuloplasty (p<.0001)." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD, standard deviation; IQR, interquartile range; LVEDd, left ventricular end-diastolic diameter; PTFE, polytetrafluoroethylene." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=547 n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male gender,n(%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">505 (92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, y, median [IQR] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 [33–48] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indication</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aortic regurgitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">523 (96) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Active endocarditis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aortic regurgitation grade,n(%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III or IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">456 (83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cusp fusion</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right-left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">462 (84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right-nonfused \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left-nonfused \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">398 (73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">149 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Annulus diameter, median [IQR] mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 [16–41] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEDd, mean±SD mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64±8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fused cusp</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central plication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">422 (77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triangular resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 (9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Annular support,n(%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">400 (73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PTFE suture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">361 (66) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyester \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concomitant procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mitral valve repair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atrial ablation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coronary artery bypass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tricuspid valve repair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Closure of patent foramen ovale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pacemaker implantation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (0.55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perfusion time, mean±SD min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50±19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myocardial ischemia, mean±SD min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32±13 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3242706.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Perioperative patient data." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical significance of the bicuspid aortic valve" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Ward" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heart.83.1.81" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2000" "volumen" => "83" "paginaInicial" => "81" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10618341" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "State-of-the art bicuspid aortic valve repair in 2020" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Ehrlich" 1 => "L. de Kerchove" 2 => "J. Vojacek" 3 => "M. Boodhwani" 4 => "I. El-Hamamsy" 5 => "R. De Paulis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pcad.2020.04.010" "Revista" => array:6 [ "tituloSerie" => "Prog Cardiovasc Dis" "fecha" => "2020" "volumen" => "63" "paginaInicial" => "457" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32380025" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of aortic complications in patients with bicuspid aortic valves" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.I. Michelena" 1 => "A.D. Khanna" 2 => "D. Mahoney" 3 => "E. Margaryan" 4 => "Y. Topilsky" 5 => "R.M. Suri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2011.1286" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2011" "volumen" => "306" "paginaInicial" => "1104" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21917581" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of conservative repair of rheumatic aortic valve insufficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Durán" 1 => "J. Alonso" 2 => "L. Gaite" 3 => "C. Alonso" 4 => "J.C. Cagigas" 5 => "L. Marce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/1010-7940(88)90075-9" "Revista" => array:7 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "1988" "volumen" => "2" "paginaInicial" => "217" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3272225" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022346814006642" "estado" => "S300" "issn" => "00223468" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valvuloplasty for aortic insufficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.M. Cosgrove" 1 => "E.R. Rosenkranz" 2 => "W.G. Hendren" 3 => "J.C. Bartlett" 4 => "W.J. Stewart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1991" "volumen" => "102" "paginaInicial" => "571" "paginaFinal" => "576" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1921433" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.E. David" 1 => "C.M. Feindel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1992" "volumen" => "103" "paginaInicial" => "617" "paginaFinal" => "621" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1532219" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Remodeling of the aortic valve anulus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Sarsam" 1 => "M. Yacoub" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1993" "volumen" => "105" "paginaInicial" => "435" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8445922" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of differentiated anatomic reconstruction of bicuspid aortic valves" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U. Schneider" 1 => "C. Hofmann" 2 => "J. Schöpe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamacardio.2020.3749" "Revista" => array:5 [ "tituloSerie" => "JAMA Cardiol" "fecha" => "2020" "volumen" => "5" "paginaInicial" => "1366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32936224" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valve configuration determines long-term results after repair of the bicuspid aortic valve" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Aicher" 1 => "T. Kunihara" 2 => "O. Abou Issa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.934679" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "178" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21200006" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "(Almost) all nonstenotic bicuspid aortic valves should be preserved or repaired" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Miyahara" 1 => "U. Schneider" 2 => "L. Morgenthaler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.semtcvs.2019.03.008" "Revista" => array:7 [ "tituloSerie" => "Semin Thorac Cardiovasc Surg" "fecha" => "2019" "volumen" => "31" "paginaInicial" => "656" "paginaFinal" => "660" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30980934" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1550728919311104" "estado" => "S300" "issn" => "15507289" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valve configuration determines long-term results after repair of the bicuspid aortic valve" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Aicher" 1 => "T. Kunihara" 2 => "O. Abou Issa" 3 => "B. Brittner" 4 => "S. Gräber" 5 => "H.J. Schäfers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.934679" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "178" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21200006" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cusp height in aortic valves" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.-J. Schäfers" 1 => "W. Schmied" 2 => "G. Marom" 3 => "D. Aicher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2012.06.053" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2013" "volumen" => "146" "paginaInicial" => "269" "paginaFinal" => "274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22853942" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new approach to the assessment of aortic cusp geometry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.-J. Schäfers" 1 => "B. Bierbach" 2 => "D. Aicher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2006.04.032" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2006" "volumen" => "132" "paginaInicial" => "436" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16872982" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U. Schneider" 1 => "C. Hofmann" 2 => "D. Aicher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2016.06.072" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2017" "volumen" => "103" "paginaInicial" => "504" "paginaFinal" => "510" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27663792" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Lancellotti" 1 => "C. Tribouilloy" 2 => "A. Hagendorff" 3 => "B.A. Popescu" 4 => "T. Edvardsen" 5 => "L.A. Pierard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ehjci/jet105" "Revista" => array:7 [ "tituloSerie" => "Eur Heart J Cardiovasc Imaging" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "611" "paginaFinal" => "644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23733442" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673611608143" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Hammermeister" 1 => "G.K. Sethi" 2 => "W.G. Henderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0735-1097(00)00834-2" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2000" "volumen" => "36" "paginaInicial" => "1152" "paginaFinal" => "1158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11028464" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprotheses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Oxenham" 1 => "P. Bloomfield" 2 => "D.J. Wheatley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Heart Br Card Soc" "fecha" => "2003" "volumen" => "89" "paginaInicial" => "715" "paginaFinal" => "721" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observed and relative survival after aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Kvidal" 1 => "R. Bergström" 2 => "L.G. Hörte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0735-1097(99)00584-7" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2000" "volumen" => "35" "paginaInicial" => "747" "paginaFinal" => "756" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10716479" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Remodeling root repair with an external aortic ring annuloplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Lansac" 1 => "I. Di Centa" 2 => "G. 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Reparación aislada de la válvula aórtica bicúspide: experiencia de más de dos décadas

Tristan Ehrlich1, Karen B. Abeln1, Lennart Froede, Flora Schmitt, Christian Burgard, Hans-Joachim Schäfers

Corresponding author

h-j.schaefers@uks.eu

Corresponding author.

Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The bicuspid aortic valve &#40;BAV&#41; is the most frequent congenital cardiac anomaly&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> It is characterized by partial or complete fusion between two cusps and the presence of a nonfused cusp&#46; Prolapse of the fused cusp and annular dilatation are the most common intraoperative findings&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Patients with a bicuspid aortic valve frequently require surgical intervention for aortic regurgitation &#40;AR&#41; and&#47;or aneurysm at a young age&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Preservation or repair of the aortic valve has evolved in the past 20 years&#46; First attempts were made at treating isolated aortic regurgitation by repair&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;5</span></a> Also operations were developed to treat patients with aortic root aneurysm and presumably normal cusps&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#44;7</span></a> With increasing knowledge of the anatomy of the aortic valve and repair options&#44; both procedures have progressed in the past 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Repair leads to a high freedom from valve-related complications and good survival if an adequate valve durability can be achieved&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the meantime&#44; aortic valve repair has become a routine procedure in experienced centers&#44; and most BAVs can be preserved or repaired&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> Anatomic characteristics of the valves have been defined that require to be addressed&#44; such as commissural orientation&#44; annular dilatation or prolapse&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Thus&#44; rather than improvising the operation&#44; repair has changed into a systematic approach with clear identification and subsequent correction of the mechanisms leading to regurgitation&#46; In particular&#44; using the concepts of effective height<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> and geometric height&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> excellent repair durability and freedom from valve-related complications have been achieved&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;9</span></a> Creation of symmetric commissural orientation has improved repair durability further&#46; In addition&#44; we introduced a suture annuloplasty to correct annular dilatation with good midterm results&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">During the past 20 years&#44; we have consistently applied this differentiated anatomic concept in the repair of BAVs&#46; With follow-up reaching more than 20 years&#44; we now intend to analyze the long-term durability of isolated BAV repair&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0025" class="elsevierStylePara elsevierViewall">Between October 1998 and December 2020&#44; 547 patients with a bicuspid aortic valve underwent isolated repair for AR in our institution&#46; These patients were the subject of this study&#46; The investigation was approved by the respective ethics committee &#40;Saarland Regional Ethics Committee&#44; CEP 202&#47;19&#41;&#44; and individual patient consent was waived for the analysis and publication in anonymized fashion&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient age ranged from 5 to 79 years &#40;mean 41&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;4 years&#41;&#46; Most of the patients were male &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>507&#59; 92&#46;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Preoperative AR was relevant &#40;III&#176; or IV&#176;&#41; in most patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>516&#59; 94&#46;33&#37;&#41;&#46; The left ventricular end-diastolic diameter ranged from 37 to 84<span class="elsevierStyleHsp" style=""></span>mm &#40;mean 63&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;4&#41;&#46; The mean sinus diameter was 36&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#44; and the mean annulus diameter was 30&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Cusp fusion was mostly seen between the right and the left coronary cusp &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>462&#59; 84&#46;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The commissural orientation of the nonfused cusp varied with predominant orientation of 160&#176; or more &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>353&#59; 64&#46;5&#37;&#41;&#46; An asymmetric orientation &#40;140&#8211;155&#176;&#41; was present in 160 patients &#40;29&#46;3&#37;&#41; and a very asymmetric orientation &#40;&#60;140&#176;&#41; was observed in 51 individuals &#40;9&#46;3&#37;&#41;&#46; Limited cusp calcification was present in 47 individuals &#40;8&#46;6&#37;&#41;&#44; in most instances in the raphe&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgical technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">The chest was opened via median sternotomy&#44; and aorta and right atrium were cannulated&#46; The aorta was opened via transverse incision 5&#8211;10<span class="elsevierStyleHsp" style=""></span>mm above the sinotubular junction&#44; and blood cardioplegia was given directly into the coronary ostia&#46; The circumferential orientation was determined and maintained using stay sutures placed into the commissures and fixed to the chest wall of the patient&#46; Valve assessment included measurement of both geometric and effective height&#44; the diameter of the basal ring was evaluated by direct intubation using a Hegar dilator&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Repair was performed if the geometric height of the nonfused cusp exceeded 20<span class="elsevierStyleHsp" style=""></span>mm in order to rule out relevant retraction&#44; otherwise valve replacement was performed&#46; Prolapse was defined as an effective height less than 9<span class="elsevierStyleHsp" style=""></span>mm in the nonfused cusp&#46; In the fused cusp&#44; prolapse was determined by visual comparison of the height of the free cusp margin relative to the nonfused cusp&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Prolapse of the fused cusp was corrected by plication of the central free margin&#46; A triangular resection was performed if extreme tissue redundancy&#44; dense fibrosis&#44; or limited calcification made direct tissue adaptation difficult or impossible&#46; In case of more extensive calcification&#44; a patch of autologous pericardium was inserted&#46; The patch was trimmed and inserted into the tissue defect of the fused cusp using continuous polypropylene suture &#40;Prolene 5-0&#44;Ehicon&#44; Hamburg&#44; Germany&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A suture annuloplasty was added to reduce dilatation of the basal ring if it was larger than 26<span class="elsevierStyleHsp" style=""></span>mm&#46; In the first 39 patients&#44; a braided polyester suture was used&#44; in the remaining 361 individuals an expanded polytetrafluorethylene &#40;PTFE&#41; was employed &#40;Gore-Tex CV-0&#59; WL Gore and Associates&#44; Munich&#44; Germany&#41;&#46; As described previously &#40;&#41;&#44; the annuloplasty suture was either tied around a 21<span class="elsevierStyleHsp" style=""></span>mm&#44; 23<span class="elsevierStyleHsp" style=""></span>mm&#44; or 25<span class="elsevierStyleHsp" style=""></span>mm Hegar dilator according to body surface area &#40;less than versus greater than or equal to 2<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Follow-up</span><p id="par0060" class="elsevierStylePara elsevierViewall">All patients were seen regularly by referring cardiologists or the institutional clinic&#46; Echocardiograms or their reports from both institutions and patients&#8217; cardiologists were reviewed&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> In addition&#44; the patients were contacted via phone or seen in clinic to determine current functional status&#46; The cause of death was determined by review of hospital charts or information was sought from respective primary care physicians&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Follow up was 92&#37; complete &#40;3341 patient-years&#41; with a mean follow-up of 73&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>56 months &#40;median 59&#46;9 months&#41;&#46; The first time of AI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 was recorded for a time-to-event analysis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Continuous data are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; Data taken from the Kaplan&#8211;Meier curve are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#46; A <span class="elsevierStyleItalic">p</span> value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46; Differences between continuous variables were compared by Student&#39;s <span class="elsevierStyleItalic">t</span>-test or by Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test in case of inhomogeneous variances&#46; Categorical data were compared using chi-square test&#46; All data were analyzed using statistical package SPSS version 28 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; In logistic regression analysis&#44; a <span class="elsevierStyleItalic">p</span> value less than 0&#46;10 in the univariable analysis was defined for entry into the multivariable analysis&#46; We applied a stepwise procedure for selecting variables based on the Wald criterion of forward induction&#46; We ended up with the following results&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">Concomitant procedures were performed in 59 patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#59; these included coronary artery bypass grafting &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; mitral repair &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&#44; tricuspid valve repair &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; and left atrial ablation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#46; Plication of the fused cusp was performed in 422 instances &#40;77&#46;1&#37;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The duration of myocardial ischemia ranged from 12 to 118<span class="elsevierStyleHsp" style=""></span>min &#40;mean 32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The mean time of extracorporeal circulation time was 49&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;7<span class="elsevierStyleHsp" style=""></span>min&#46; Reexploration for hemorrhage was necessary in 7 patients &#40;1&#46;3&#37;&#41;&#46; Three patients &#40;0&#46;55&#37;&#41; required pacemaker implantation for postoperative atrioventricular block were necessary&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Survival</span><p id="par0085" class="elsevierStylePara elsevierViewall">One patient died early for an in-hospital mortality of 0&#46;18&#37;&#46; The patient underwent surgery for active endocarditis and suffered a perioperative stroke with intracerebral hemorrhage&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Over time&#44; 12 patients &#40;2&#46;2&#37;&#41; died between 2 and 157 months postoperatively&#46; Survival was 98&#46;2&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 at 5 years&#44; 96&#46;9&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 at 10 years&#44; and 93&#46;2&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7 at 15 and 20 years&#46; With the addition of suture annuloplasty&#44; survival was 99&#46;7&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3 at 10 years&#59; it was 91&#46;4&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7 without annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; No fatal outcome was directly or indirectly related to inadequate function of the repaired aortic valve&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">By logistic regression&#44; lack of an annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#59; OR 23&#41; and presence of limited valve calcification &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#59; OR 4&#46;1&#41; were independent predictors of death&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Reoperation</span><p id="par0100" class="elsevierStylePara elsevierViewall">Forty-eight patient &#40;8&#46;8&#37;&#41; required a reoperation on the aortic valve between 1 and 147 months postoperatively&#46; Freedom from reoperation was 92&#46;2&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3 at 5 years&#44; 86&#46;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2 at 10&#44; and 83&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9 at 15 and 20 years respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; With the addition of suture annuloplasty&#44; freedom from reoperation was 97&#46;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9 at 10 years&#59; it was 67&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6 without annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">By separate logistic regression analysis&#44; the use of pericardial patches &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#59; OR 2&#46;6&#41;&#44; subcommissural plication &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#59; OR 7&#46;3&#41; and the lack of an annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#59; OR 17&#41; were independent predictors for reoperation&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Freedom from AI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>II</span><p id="par0110" class="elsevierStylePara elsevierViewall">There was a high proportion of competent aortic valves or only trivial regurgitation at the times of discharge &#40;AI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>I&#59; 98&#46;5&#37;&#41;&#46; The proportion of functionally competent aortic valves at discharge was higher with the use of annuloplasty &#40;AI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>I&#59; 99&#37; vs 91&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Valve function remained constant in the majority of patients&#44; while some developed recurrent regurgitation&#46; Freedom from AI<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805;</span><span class="elsevierStyleHsp" style=""></span>II was 90&#46;2&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4 at 5&#44; 83&#46;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3 at 10 and 77&#46;7&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4 at 15 years&#46; The Kaplan&#8211;Meier analysis showed a significant effect of suture annuloplasty in freedom from recurrent AI<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805;</span><span class="elsevierStyleHsp" style=""></span>II at 10 years &#40;with 90&#46;4&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&#59; without 68&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Independent predictors for recurrent AI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>II were the use of subcommissural plication &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#59; OR 2&#46;8&#41;&#44; the use of pericardial patches &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#59; OR 5&#46;6&#41;&#44; and the presence of cusp calcification &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#59; OR 3&#46;9&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">With the development of heart valve prostheses in the 1960s&#44; aortic valve replacement became the standard treatment for aortic regurgitation&#46; Long-term studies&#44; however&#44; showed valve-related complications in a relevant proportion of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16&#44;17</span></a> In addition&#44; a non-negligible rate of valve-related mortality was observed&#44; which was associated with reduced life expectancy after aortic valve replacement&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> In addition&#44; the risk of reoperation persisted&#44; even after mechanical valve replacement&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> Another pitfall of mechanical valves is the lifelong need of anticoagulation&#44; with its associated risks&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">By contrast&#44; aortic valve repair has been shown to largely eliminate these risks if good repair durability was achieved&#46; With repair&#44; survival equivalent to that of the age- and gender-matched general population&#44; and excellent quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Repair of regurgitant bicuspid aortic valves has been performed for more than two decades&#46; Initially&#44; surgeons relied on a visual assessment of the cusps&#46; Although early results were good&#44; mid-term studies showed a relevant attrition of valve function&#46; Based on the analysis of valve failures&#44; we proposed the concept of effective height as a quantitative indicator of valve configuration&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> Others have confirmed the benefit of this concept&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Further analysis of repair failure identified annular dilatation as an important predictor&#46; Since the introduction of the suture annuloplasty concept&#44; the durability of isolated bicuspid aortic valve repair could be drastically improved&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> This observation is confirmed by our current analysis&#46; We have now been able to find a positive association between annuloplasty and not only freedom from recurrent aortic regurgitation&#44; but also survival&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Local complications associated with suture annuloplasty were almost exclusively seen early in the experience and with the use of braided polyester sutures&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> The complications have been largely eliminated by using expanded polytetrafluorethylene instead&#46; Interference with the circumflex artery was in only few instances and could be treated by removal of the suture&#46; Thus&#44; our current results of aortic valve repair show a stability that is at least comparable if not superior to that described by others applying an external annuloplasty ring&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Our initial enthusiasm about the excision of calcium and partial cusp replacement using pericardium has faded with the recognition of a high incidence of reoperations in the first years&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> Resection of limited plaques with direct approximation of cusp tissue still seems to be an acceptable approach&#46; We have abandoned the use of pericardium for cusp repair and now propose replacement in these instances&#46; A caveat remains with cusp calcium being a predictor of reduced survival in our current analysis&#46; It is unclear whether this is due to preserving suboptimal valves&#44; or whether this is merely an indicator of a patient-specific tendency to develop atherosclerosis at an earlier age&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our current data confirm the applicability and stability of the anatomy-based repair strategy with good repair durability&#46; Using this concept&#44; we are now able to achieve stable repair results for the majority of patients&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limitations</span><p id="par0155" class="elsevierStylePara elsevierViewall">The present study has limitations owing to its retrospective and monocentric design&#46; It includes modifications introduced over time&#44; nevertheless&#44; surgical bias is limited by the fact that one surgeon substantially participated in all procedures&#46; Moreover&#44; our findings need to be interpreted with caution owing to multiple testing and the size of different subgroups&#46; Despite the adjustment for possible confounders&#44; residual confounding may have been present&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nonetheless&#44; to our knowledge&#44; this is the first study on isolated bicuspid valve repair incorporating a population of more than 500 participants with a follow-up exceeding 20 years&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Isolated bicuspid aortic valve repair is associated with excellent survival&#44; and the majority of BAV repairs will remain stable over more than 10 years&#46; The use of an annuloplasty improves repair durability and is associated with improved survival&#46; Cusp calcification and cusp repair using a pericardial patch are predictors for early valve failure&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Patient and public involvement</span><p id="par0170" class="elsevierStylePara elsevierViewall">Patients were not involved in the research process of this study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Sources of funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Repair of the bicuspid aortic valve has evolved in the past 20 years&#46; The aim of this study was to review two decades of experience and analyze the long-term stability of BAV repair&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between 10&#47;1998 and 12&#47;2020&#44; 547 adult patients &#40;92&#37; male&#59; 41&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;4 years&#41; underwent a bicuspid aortic valve repair with &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>400&#41; or without &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>147&#41; annuloplasty&#46; Sinus plication was performed in 175 instances &#40;32&#37;&#41;&#46; Mean follow-up of 73&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>56 months &#40;median 59&#46;9 months&#41;&#59; it was 92&#37; complete&#46; Survival and freedom from reoperation were calculated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Survival at 20 years was 93&#46;2&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&#44; freedom from reoperation at 20 years was 83&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&#46; Freedom from AI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>II was 77&#46;7&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4 at 15 years&#46; By logistic regression analysis&#44; the use of pericardial patches for cusp repair &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#59; OR 2&#46;6&#41;&#44; the use of subcommissural plication &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#59; OR 7&#46;3&#41;&#44; and the lack of annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#59; OR 17&#41; were independent predictors for reoperation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Isolated bicuspid aortic valve repair is associated with excellent survival&#44; and the majority of BAV repairs will remain stable over more than 10 years&#46; The use of an annuloplasty improves repair durability and patient survival&#46; Cusp calcification and cusp repair using a pericardial patch are predictors for early valve failure&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Background"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La reparaci&#243;n de la v&#225;lvula a&#243;rtica bic&#250;spide ha evolucionado en los &#250;ltimos 20 a&#241;os&#46; El objetivo de este estudio fue revisar nuestra experiencia de dos d&#233;cadas y analizar la estabilidad a largo plazo de la reparaci&#243;n de BAV&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre octubre de 1998 y diciembre de 2020&#44; 547 pacientes adultos &#40;92&#37; varones&#59; 41&#44;9 &#177; 13&#44;4 a&#241;os&#41; se sometieron a una reparaci&#243;n de la v&#225;lvula a&#243;rtica bic&#250;spide con &#40;n &#61; 400&#41; o sin &#40;n &#61; 147&#41; anuloplastia&#46; La plicatura de senos se realiz&#243; en 175 casos &#40;32&#37;&#41;&#46; Seguimiento medio de 73&#44;3 &#177; 56 meses &#40;mediana 59&#44;9 meses&#41;&#59; fue completado en un 92&#37;&#46; Se calcul&#243; la supervivencia y la ausencia de reoperaci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La sobrevida a los 20 a&#241;os fue de 93&#44;2&#37; &#177; 2&#44;7&#44; la ausencia de reoperaci&#243;n a los 20 a&#241;os fue de 83&#44;7 &#177; 2&#44;9&#46; La ausencia de IA &#8805; II fue del 77&#44;7&#37; &#177; 3&#44;4 a los 15 a&#241;os&#46; Mediante an&#225;lisis de regresi&#243;n log&#237;stica&#44; el uso de parches peric&#225;rdicos para la reparaci&#243;n de las c&#250;spides &#40;p &#61; 0&#44;019&#59; OR 2&#46;6&#41;&#44; el uso de la plicatura subcomisural &#40;p &#60; 0&#44;0001&#59; OR 7&#44;3&#41;&#44; y la falta de anuloplastia &#40;p &#60; 0&#44;0001&#59; OR 17&#41; fueron predictores independientes para la reoperaci&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La reparaci&#243;n aislada de la v&#225;lvula a&#243;rtica bic&#250;spide se asocia con una excelente supervivencia&#44; y la mayor&#237;a de las reparaciones de BAV se mantendr&#225;n estables durante m&#225;s de 10 a&#241;os&#46; El uso de una anuloplastia mejora la durabilidad de la reparaci&#243;n y la supervivencia del paciente&#46; La calcificaci&#243;n de la c&#250;spide y la reparaci&#243;n de la c&#250;spide con un parche peric&#225;rdico son predictores de la falla temprana de la v&#225;lvula&#46;</p></span>"
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            "titulo" => "Antecedentes"
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            "identificador" => "abst0035"
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            "identificador" => "abst0040"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Freedom from reoperation after repair of regurgitant bicuspid aortic valves&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Freedom from reoperation with and without annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46;</p>"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Freedom from AI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>II with and without annuloplasty &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; IQR&#44; interquartile range&#59; LVEDd&#44; left ventricular end-diastolic diameter&#59; PTFE&#44; polytetrafluoroethylene&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Male gender&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">505 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Age&#44; y&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">523 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Active endocarditis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">I</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">II</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">III or IV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">149 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Annulus diameter&#44; median &#91;IQR&#93; mm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#91;16&#8211;41&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LVEDd&#44; mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">SD mm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">422 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Triangular resection</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Patch</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Annular support&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">400 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PTFE suture</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">361 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Polyester</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">31 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">18 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Coronary artery bypass</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Closure of patent foramen ovale</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Pacemaker implantation</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;0&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Perfusion time&#44; mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">SD min</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Myocardial ischemia&#44; mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">SD min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Perioperative patient data&#46;</p>"
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        0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical significance of the bicuspid aortic valve"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Ward"
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                    0 => array:2 [
                      "doi" => "10.1136/heart.83.1.81"
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                        "volumen" => "83"
                        "paginaInicial" => "81"
                        "paginaFinal" => "85"
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                          0 => array:2 [
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                      "titulo" => "State-of-the art bicuspid aortic valve repair in 2020"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Ehrlich"
                            1 => "L&#46; de Kerchove"
                            2 => "J&#46; Vojacek"
                            3 => "M&#46; Boodhwani"
                            4 => "I&#46; El-Hamamsy"
                            5 => "R&#46; De Paulis"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.pcad.2020.04.010"
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                        "tituloSerie" => "Prog Cardiovasc Dis"
                        "fecha" => "2020"
                        "volumen" => "63"
                        "paginaInicial" => "457"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Incidence of aortic complications in patients with bicuspid aortic valves"
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                            4 => "Y&#46; Topilsky"
                            5 => "R&#46;M&#46; Suri"
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                        "paginaInicial" => "1104"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21917581"
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                            4 => "J&#46;C&#46; Cagigas"
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                    0 => array:2 [
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                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "1988"
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                        "paginaInicial" => "217"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3272225"
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                      "titulo" => "Valvuloplasty for aortic insufficiency"
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                          "autores" => array:5 [
                            0 => "D&#46;M&#46; Cosgrove"
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                            4 => "W&#46;J&#46; Stewart"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
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                          "etal" => false
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                      "titulo" => "Remodeling of the aortic valve anulus"
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                            0 => "M&#46;A&#46; Sarsam"
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                        "tituloSerie" => "J Thorac Cardiovasc Surg"
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                        "paginaInicial" => "435"
                        "paginaFinal" => "438"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8445922"
                            "web" => "Medline"
                          ]
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                      "titulo" => "Long-term results of differentiated anatomic reconstruction of bicuspid aortic valves"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "U&#46; Schneider"
                            1 => "C&#46; Hofmann"
                            2 => "J&#46; Sch&#246;pe"
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                        "tituloSerie" => "JAMA Cardiol"
                        "fecha" => "2020"
                        "volumen" => "5"
                        "paginaInicial" => "1366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32936224"
                            "web" => "Medline"
                          ]
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                      "titulo" => "Valve configuration determines long-term results after repair of the bicuspid aortic valve"
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                            0 => "D&#46; Aicher"
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                            2 => "O&#46; Abou Issa"
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                        "tituloSerie" => "Circulation"
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                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21200006"
                            "web" => "Medline"
                          ]
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                      "titulo" => "&#40;Almost&#41; all nonstenotic bicuspid aortic valves should be preserved or repaired"
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                          "etal" => true
                          "autores" => array:3 [
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                            2 => "L&#46; Morgenthaler"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1053/j.semtcvs.2019.03.008"
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                        "tituloSerie" => "Semin Thorac Cardiovasc Surg"
                        "fecha" => "2019"
                        "volumen" => "31"
                        "paginaInicial" => "656"
                        "paginaFinal" => "660"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30980934"
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                      "titulo" => "Valve configuration determines long-term results after repair of the bicuspid aortic valve"
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                    0 => array:2 [
                      "titulo" => "Cusp height in aortic valves"
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                            0 => "H&#46;-J&#46; Sch&#228;fers"
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                    0 => array:2 [
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                        "volumen" => "146"
                        "paginaInicial" => "269"
                        "paginaFinal" => "274"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22853942"
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                    0 => array:2 [
                      "titulo" => "A new approach to the assessment of aortic cusp geometry"
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                        "paginaFinal" => "438"
                        "link" => array:1 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "U&#46; Schneider"
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                        "tituloSerie" => "Ann Thorac Surg"
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                0 => array:2 [
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                      "titulo" => "Recommendations for the echocardiographic assessment of native valvular regurgitation&#58; an executive summary from the European Association of Cardiovascular Imaging"
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                          "etal" => true
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                        "tituloSerie" => "Eur Heart J Cardiovasc Imaging"
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                        "paginaInicial" => "611"
                        "paginaFinal" => "644"
                        "link" => array:1 [
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                          "pii" => "S0140673611608143"
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                    0 => array:2 [
                      "titulo" => "Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve&#58; final report of the Veterans Affairs randomized trial"
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                        "tituloSerie" => "J Am Coll Cardiol"
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                        "paginaFinal" => "1158"
                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Twenty-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprotheses"
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Article information

ISSN: 11340096
Original language: English

DOI:10.1016/j.circv.2022.02.019

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Year/Month	Html	Pdf	Total

2024 November	7	2	9
2024 October	38	19	57
2024 September	51	17	68
2024 August	54	20	74
2024 July	32	12	44
2024 June	49	17	66
2024 May	42	20	62
2024 April	44	14	58
2024 March	46	18	64
2024 February	53	19	72
2024 January	33	9	42
2023 December	29	16	45
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2023 August	47	5	52
2023 July	20	8	28
2023 June	33	8	41
2023 May	38	8	46
2023 April	32	4	36
2023 March	14	5	19
2023 February	5	7	12
2023 January	8	14	22
2022 December	9	8	17
2022 November	14	15	29
2022 October	10	7	17
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