Does Intercommissural Distance Shortening in Bicuspid Aortic Valve Repair Improve Valve Opening Area?

BACKGROUND Standardized bicuspid aortic valve (BAV) repair makes 2 symmetrical cusps by plicating the fused cusp, which is accompanied by risk of aortic stenosis.Here, the effect of improving cusp mobility by shortening the intercommissural distance (ICD) on increasing the aortic valve area was examined in a BAV model using a pulsatile flow simulator.METHODS Six pairs of symmetrical BAV were created in a neo-Valsalva graft with bovine pericardium (free margin length, 26 mm; geometric height, 20 mm), which were incorporated into a pulsation circuit simulator.The ICD was gradually shortened, and the forward flow, leakage flow, pressure gradient, and aortic valve area were measured.The average value of a total of 18 measurements (3 for each model) was examined. RESULTSForward flow remained constant and leakage increased slightly with ICD shortening, but the differences were not statistically significant (P .17).Peak and mean transvalvular pressure gradient were significantly reduced by ICD shortening (peak: control 26.75 4.33 mm Hg vs 22-mm ICD 23.85 2.91 mm Hg, P < .05;mean: control 17.57 3.59 mmHg vs 20-mm ICD 14.76 2.40 mm Hg, P .01).Aortic valve area was increased significantly by ICD shortening (control 2.03 0.37 cm 2 vs 18-mm ICD 2.71 0.47 cm 2 , P <.01).CONCLUSIONS With shortening of the ICD, the effect of increasing the aortic valve area and decreasing the pressure gradient was confirmed.Shortening the sinotubular junction diameter ( ICD) is important in aortic valvuloplasty for BAV.