Surgeons at the UCSF Cardiac Surgery Program specialize in aortic valve repair and replacement, options that can resolve acute symptoms and improve life expectancy. Recently, two patients with bicuspid aortic valves presented with signs of regurgitation, including shortness of breath, fatigue and chest pain.
“Sometimes two aortic leaflets can be fused, causing a bicuspid valve,” said cardiothoracic surgeon Marko T. Boskovski, MD, MHS, MPH. “This is present in about 1% of the population. I lead the Ross procedure and aortic valve repair program. These procedures are related in that they’re mostly performed on relatively young people with aortic valve disease, like these two patients.”
Two approaches to aortic valve regurgitation
A 27-year-old man with significant leaking in his bicuspid aortic valve came to UCSF for treatment. Boskovski determined that valve repair was the best option because the quality of the leaflets was normal. “Even though he had a bicuspid valve, which is an unusual variant, we were able to repair it.”
The patient was discharged within days of surgery and is doing well. Because the team repaired his valve rather than replacing it with a mechanical one, he doesn’t need to take blood thinners for the rest of his life.
An active 55-year-old man with bicuspid aortic valve regurgitation wanted to avoid mechanical replacement. “He had a lot of calcification on his leaflets, so we opted for the Ross procedure,” Boskovski said. This involved replacing the patient’s diseased aortic valve with his pulmonary valve and replacing his pulmonary valve with a homograft. “The pulmonary valve essentially takes on the morphology of an aortic valve over time,” Boskovski explained. This patient was also discharged within a week, is doing well and doesn’t need blood thinners.
“We have a dedicated team that specializes in the Ross procedure, including a dedicated cardiac anesthesiologist and dedicated cardiac perfusionists,” Boskovski said. “The ICU staff have all had training in the Ross procedure and the required pre- and post-op care.”
While these two patients have bicuspid aortic valves, the same treatment algorithm applies for patients with tricuspid aortic valves.
Positive patient outcomes at high-volume specialty center
“UCSF is a high-volume center for complex aortic root surgery, including the Ross procedure, aortic valve repair and valve-sparing aortic root replacement,” Boskovski said.
Over the past year and a half, the surgical team has performed about 25 aortic valve repairs and 25 Ross procedures. “All the patients are back to doing their activities, even running marathons. Their valves are functioning very well.”
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