Ann Thorac Surg 2008;85:362-363. doi:10.1016/j.athoracsur.2007.06.095
© 2008 The Society of Thoracic Surgeons
Correspondence
Bicuspid Aortic Valve: About Natural History of Ascending Aorta Aneurysms
Aldo Cannata, MD,
Claudio Francesco Russo, MD,
Ettore Vitali, MD
Department of Cardiac Surgery, Angelo De Gasperis Department of Cardiac Surgery, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore, 3, Milan 20162, Italy
(Email: aldo.cannata{at}libero.it).
To the Editor:
We read with great interest the article by Davies and colleagues [1]. We congratulate the authors for their clinical research about the natural history and surgical management of aortic dilatation in patients with a bicuspid aortic valve (BAV). Authoritative recommendations are available regarding management of the dilated aorta in patients affected by a severely diseased BAV [2]. However, guidelines are still lacking in case of mild to moderate aortic dilatation associated with a non-severely dysfunctional BAV. The authors observed a similar incidence of aortic complications during follow-up between the unoperated patients with BAV and with tricuspid aortic valve (TAV). In our opinion, such results could be influenced by two factors. First, the length of follow-up in a mean of 65.1 months, independently of operative repair could be too short to observe a difference in terms of events between BAV and TAV. In our previous study [3], we observed that in patients with BAV the incidence of aortic complications were significantly higher as compared with TAV. More importantly, such a difference became evident only after 10 years of follow-up, probably because of a time-dependent effect. Second, in the author series, 77.1% of BAV patients had operations on the aorta during follow-up. Such high incidence of surgical repair does influence the natural history of the disease, preventing complications in a very effective way. We believe these factors could lead to an underestimation of incidence of events in the long term. Moreover, in how many cases has the indication to operation been suggested by the aortic dilatation rather than BAV disease?
In conclusion, the article by Davies and colleagues [1] gives further insights to the evolution of aortic disease in BAV patients. However, not all patients with a BAV have aortic dilatation develop [4]. Therefore, the present challenge is to identify which patients are exposed to an increased risk of aneurysm development and complications.
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References
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- Davies RR, Kaple RK, Mandapati D, et al. Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve Ann Thorac Surg 2007;83:1338-1344.[Abstract/Free Full Text]
- American College of Cardiology/American Heart Association Task Force on Practice GuidelinesSociety of Cardiovascular AnesthesiologistsSociety for Cardiovascular Angiography and Interventions ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeonset al Circulation 2006;114:e84-e231.[Free Full Text]
- Russo CF, Mazzetti S, Garatti A, et al. Aortic complications after bicuspid aortic valve replacement: long-term results Ann Thorac Surg 2002;74:S1773-S1776discussion S1792–9.[Abstract/Free Full Text]
- Nistri S, Sorbo, MD, Marin M, Palisi M, Scognamiglio R, Thiene G. Aortic root dilatation in young men with normally functioning bicuspid aortic valves Heart 1999;82:19-22.[Abstract/Free Full Text]
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