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Comment & Response
June 2, 2021

Advances in Aortic Valve Repair, Particularly Bicuspid Valves

Author Affiliations
  • 1Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
  • 2The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
JAMA Cardiol. 2021;6(8):977-978. doi:10.1001/jamacardio.2021.1245

To the Editor We read with interest the article by Schneider and colleagues.1 Our experience is similar with some newer advances since the early 2000s, when we had the pleasure of having the senior author, Hans-Joachim Schäfers, MD, visit us and observe our root remodeling for bicuspid valve repairs for enlarged roots. In a 2014 series of 728 bicuspid repairs2 and a 2018 series of 1962 aortic valve repairs,3 1124 having undergone operations between 2001 and 2011, improvement was shown over time. Similar to Schneider et al,1 we noted the risks associated with calcified leaflets for aortic valve repairs as well as improved results bracing the root by either remodeling or reimplantation. Nevertheless, the benefits of reimplantation may not be as great for bicuspid valves with reimplantation compared with trileaflet valves.2,4,5 Importantly, we also noted that a figure-of-8 suspensory stitch on the commissures improved long-term durability of repairs.2,3

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