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

Claudio F Russo1, Simone Mazzetti, Andrea Garatti

  • 1Division of Cardiovascular Surgery, Niguarda Hospital, Milan, Italy. f.russo@tiscali.it

The Annals of Thoracic Surgery
|November 21, 2002
PubMed

Insights

Patients with bicuspid aortic valve (BAV) face higher risks of aortic dissection and death after aortic valve replacement (AVR). Prophylactic ascending aorta replacement is recommended for BAV patients undergoing AVR.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Bicuspid aortic valve (BAV) is a known risk factor for aortic dissection and aneurysm.
  • Long-term aortic changes after aortic valve replacement (AVR) in BAV patients require further investigation.

Purpose of the Study:

  • To evaluate long-term changes in the ascending aorta among patients with BAV compared to tricuspid aortic valve (TAV) patients after AVR.

Main Methods:

  • A cohort of 100 patients undergoing AVR was divided into two groups: BAV (n=50) and TAV (n=50).
  • Patients were monitored for long-term outcomes, including aortic dissection, sudden death, and ascending aorta diameter via echocardiogram.
  • Exclusion criteria included hypertension and Marfan's syndrome.

Main Results:

  • Patients with BAV experienced significantly higher rates of late acute aortic dissection (10% vs 0%) and sudden death (p=0.0001).
  • The mean ascending aorta diameter was significantly larger in the BAV group (48.4 mm) compared to the TAV group (36.8 mm).
  • Three BAV patients required surgery for ascending aorta aneurysm (>6 cm).

Conclusions:

  • Prophylactic replacement of the ascending aorta, even if normal or mildly enlarged, is recommended during AVR in patients with BAV.
  • A similar prophylactic approach should be considered for other cardiac surgical procedures in BAV patients.
Abstract

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