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Ann Thorac Surg 2002;74:S1773-S1776
© 2002 The Society of Thoracic Surgeons

Session 1: Ascending Aorta

Aortic complications after bicuspid aortic valve replacement: long-term results

Claudio F. Russo, MDa*, Simone Mazzetti, MDa, Andrea Garatti, MDa, Elena Ribera, MDa, Angela Milazzo, MDb, Giuseppe Bruschia, Marco Lanfranconi, MDa, Tiziano Colombo, MDa, Ettore Vitali, MDa

a Division of Cardiovascular Surgery, Milan, Italy
b Division of Cardiology, Echocardiography Service, Niguarda Hospital, Milan, Italy

* Address reprint requests to Dr Russo, Division of Cardiovascular Surgery, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
e-mail: f.russo{at}tiscali.it

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR).

PATIENTS AND METHODS: One hundred consecutive patients were allocated into two groups according to the presence of BAV (group A, 50 patients) or TAV (group B, 50 patients). Mean age was 51 ± 12 years in group A, and 50 ± years 12 in group B. No patients had hypertension or Marfan’s syndrome. Until July 2001, mean follow-up was 234 ± 47 months in group A and 241 ± 43 months in group B.

RESULTS: Five patients (10%, CL 5.7 to 13.9) in group A suffered late acute aortic dissection. Acute aortic dissection (5 vs 0, p = 0.0001) and sudden death (7 vs 0, p = 0.0001) occurred more frequently in patients with BAV. All survivors were assessed by echocardiogram. The mean diameter of the ascending aorta was 48.4 mm in group A and 36.8 mm in group B. Three patients in group A were operated on because of ascending aorta aneurysm more than 6 cm in diameter.

CONCLUSIONS: As a result of our experience, we recommend a policy of prophylactic replacement of even a seemingly normal and definitely a mildly enlarged ascending aorta in cases of BAV at the moment of AVR, and consideration of a similar approach for any other cardiac surgical procedure in patients with BAV.




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