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Ann Thorac Surg 2007;84:473-478
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Replacement of the Proximal Aorta Adds No Further Risk to Aortic Valve Procedures

Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia

Accepted for publication April 16, 2007.

^_* Address correspondence to Dr Kron, PO Box 800679, 1215 Lee St, Hosp. Expansion Bldg., Room 4066, Charlottesville, VA 22908 (Email: ikron{at}virginia.edu).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: Aortic valve pathology is often associated with proximal aortic dilatation. Even after valve surgery, the proximal aorta can continue to dilate and thus be at risk for rupture, dissection, or later aortic replacement. We hypothesized that the addition of proximal aortic intervention adds no further risk to aortic valve surgery, which may avoid subsequent proximal aortic procedures or catastrophes.

Methods: Between 1996 and 2004, 430 aortic valve interventions alone and 146 aortic valves with proximal aortic replacements were identified in elective adult patients. The age in the valve-alone patients (68.8 years) was slightly higher than the valve-plus-aorta group (valve/aorta, 60.5 years; p < 0.01), but comorbidities were similar between groups. We compared groups based on hospital mortality and incidence of complications.

Results: The 30-day mortality was similar between groups (valve-alone, 3.8% versus valve/aorta, 2.7%; p = 0.5), as were rates for bleeding and operative revision (valve-alone, 6.7% versus valve/aorta, 9.5%; p = 0.5). Pulmonary (valve-alone, 23.0% versus valve/aorta, 11.6%) and renal complications (valve-alone, 8.2% versus valve/aorta, 2.7%) were higher in the valve-alone group (p = 0.02). Logistic regression demonstrated no additional risk of death, neurologic, or cardiac event with replacement of the proximal aorta.

Conclusions: Proximal aortic replacement adds no risk to the patient beyond the aortic valve intervention alone. These findings suggest proximal aortic replacement is safe for patients undergoing valve operations. Patients with a moderately enlarged proximal aorta that may dilate further should also be considered for aortic replacement at the time of valve procedures.

This article has been cited by other articles:

				C. Bassano and L. Chiariello Aortic Valve Disease With Concomitant Proximal Aorta Dilation: Surgical Strategy Ann. Thorac. Surg., April 1, 2008; 85(4): 1502 - 1503. [Full Text] [PDF]

				T. B. Reece and I. L. Kron Reply Ann. Thorac. Surg., April 1, 2008; 85(4): 1503 - 1503. [Full Text] [PDF]