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Ann Thorac Surg 2000;69:1333-1337
© 2000 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Options for repair of a bicuspid aortic valve and ascending aortic aneurysm

^a Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

Address reprint requests to Dr Sundt, Division of Cardiothoracic Surgery, Washington University School of Medicine, Suite 3106 Queeny Tower, One Barnes Hospital Plaza, St. Louis, MO 63110
e-mail: sundt{at}msnotes.wustl.edu

Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.

Background. Intrinsic abnormality of the aortic wall may explain the association of bicuspid aortic valves with ascending aortic aneurysms. Separate valve and graft repair of such lesions, rather than composite valve graft replacement, is more straightforward but leaves potentially abnormal sinuses behind.

Methods. Between January 1985 and January 1998, 45 patients underwent separate valve and graft (n = 27) or composite valve graft (n = 18) for an ascending aortic aneurysm and bicuspid aortic valve. Perioperative events and late results were compared.

Results. Patients undergoing separate valve and graft were older (mean age, 60 ± 13 vs 42 ± 12 years, p < 0.001) and were more likely to have purely stenotic (48% vs 6%, p = 0.003) than purely regurgitant (11% vs 72%, p < 0.001) disease. They were also more likely to require concomitant coronary artery bypass grafting (56% vs 6%, p = 0.001). There were no significant differences in operative risk and no known late complications related to recurrent aneurysms.

Conclusions. Root replacement with a composite valve graft can be accomplished with low operative risk and is the first choice for repair of this lesion. Separate valve and graft repair, however, yields satisfactory early and late results and remains an acceptable option, especially when the coronary ostea are not displaced or when concomitant procedures must be performed.

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