Simulation-guided outlet valve repair: early integration of computationally-derived principles of free-edge length in bicuspidization repair.

Authors

Perry Seo Choi, Alexander D Kaiser, Riya Nilkant, Amit Sharir, Umar Siddiqi, Hannah L McMullen, Alison L Marsden, Michael R Ma

Published in

Frontiers in cardiovascular medicine. Volume 13. Pages 1957668. Epub Sep 29, 2026.

Abstract

Symmetric bicuspidization repair for outlet valve pathologies relies on the surgeon's subjective assessment. Recent computational and ex-vivo work suggests sizing free-edge length to 1.57 times aortic diameter is optimal. This principle was applied clinically at our institution, and this study compares post-implementation outcomes with historical results.
All patients with attempted bicuspidization from 2011 to 2025 were queried. Primary outcome was freedom from valve-related reoperation or valve replacement. Secondary outcomes were cross-clamp time, number of bypass runs, mean transvalvular gradient, and regurgitation grade. Kaplan-Meier curves were generated for primary outcome with log-rank comparison. Secondary outcomes were compared with Wilcoxon rank-sum test.
At median age 5.9 years, fourteen patients underwent symmetric bicuspidization (9 historical, 5 simulation-guided). Valve configuration included unicuspid (n = 2), bicuspid (n = 6), tricuspid (n = 4), and quadricuspid (n = 2). Repair indication was predominantly regurgitation (n = 13/14, 93%). Five (56%) historical patients underwent reoperation compared with zero simulation-guided patients (median follow-up 948 vs. 455 days). Three (33%) historical patients required repeat bypass run, compared to zero simulation-guided. Cross-clamp time was not different between groups (72 vs. 89, p = 0.74). Acute and latest postoperative mean gradients were also not significantly different (acute: 13.5 vs. 9.6, p = 0.14; latest: 12.4 vs. 3.3, p = 0.08), though gradient variability was two to four times lower in the simulation-guided group.
This exploratory study presents promising early outcomes after prespecified, standardized sizing of the free-edge length in symmetric bicuspidization repair. Simulation-guided design can be applied in complex valve repair and may enhance early outcomes.

PMID:
42871310
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

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