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Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?

Michael A Borger1, Mark Preston, Joan Ivanov

  • 1Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4. michael.borger@uhn.on.ca

The Journal of Thoracic and Cardiovascular Surgery
|October 30, 2004
PubMed

Insights

For bicuspid aortic valve disease, ascending aorta replacement is recommended at 4.5 cm or greater. This helps prevent serious aortic complications and improve long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Genetics

Background:

  • Bicuspid aortic valve disease is a common congenital heart defect.
  • The optimal management strategy for ascending aorta dilation in these patients remains unclear.

Purpose of the Study:

  • To determine the optimal diameter for ascending aorta replacement in patients with bicuspid aortic valve disease.
  • To assess the risk of aortic complications based on ascending aorta diameter.

Main Methods:

  • Retrospective review of 201 patients with bicuspid aortic valves undergoing aortic valve replacement between 1979 and 1993.
  • Exclusion of patients who had concomitant ascending aorta replacement.
  • Long-term follow-up to assess survival and aortic complications.

Main Results:

  • Fifteen-year freedom from ascending aorta complications was significantly lower in patients with diameters 4.5-4.9 cm (43%) compared to <4.0 cm (86%) and 4.0-4.4 cm (81%).
  • Ascending aorta-related complications included aneurysm, dissection, and sudden cardiac death.
  • A diameter of 4.5 cm or greater was associated with a substantially increased risk of complications.

Conclusions:

  • Concomitant ascending aorta replacement should be strongly considered for patients with bicuspid aortic valve disease when the diameter reaches 4.5 cm or greater.
  • Early intervention can mitigate the risk of severe aortic events in this population.
Abstract

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