Is small cusp size a limitation for aortic valve repair?

OBJECTIVES: We sought to investigate cusp size limitations for valve repair in patients with aortic regurgitation (AR). METHODS: Preoperative computed tomography was performed in 105 patients. Cusp geometric height (GH) and annulus size were measured. Mean patient age was 60.7 +/- 13.7 years. Mean GH of 3 cusps was used in the analysis. Annulus cusp mismatch was graded using predicted coaptation length. Patients were categorized by mean GH into group S (GH <16 mm; n = 35) or L (GH >16 mm; n = 70). RESULTS: Preoperative mean GH was 17.1 +/- 2.3 mm. GH and body height were significantly correlated (r = 0.61). Intraoperative mean GH (18.8 +/- 2.2 mm) was larger than preoperative mean GH (P < 0.0001). However, postoperative (17.1 +/- 2.0 mm) and preoperative mean GH did not differ. Moderate AR was not present on predischarge echocardiography. Mild AR was observed in 51% and 17% of patients in groups S and L, respectively (P = 0.006). During follow-up, moderate or severe AR was observed in 14% and 10% of patients in groups S and L, respectively ( P = 0.74). Two patients in group S required reoperation for a regurgitant valve. Twenty (83%) and 15 (21%) patients in groups S and L, respectively, had severe annulus cusp mismatch before surgery. Annulus cusp mismatch resolved in most patients in group L postoperatively, whereas more than half the patients in group S still had severe mismatch. CONCLUSIONS: Small cusp size (GH <16 mm) is not necessarily a contraindication in aortic valve repair. However, most patients in this group had annulus cusp mismatch. Root replacement or secure annulus plication is mandatory to correct annulus cusp mismatch.