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Bicuspid aortic valve surgery with proactive ascending aorta repair
Lars G Svensson1, Kyung-Hwan Kim, Eugene H Blackstone
1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. svenssl@ccf.org
The Journal of Thoracic and Cardiovascular Surgery
|February 5, 2011
Summary
Proactive aortic repair during bicuspid aortic valve surgery does not increase risk and improves long-term survival. Aortic size over 4.5 cm or a ratio >8-10 warrants concurrent repair for better outcomes.
Area of Science:
- Cardiovascular Surgery
- Aortic Valve Disease
- Aortic Aneurysm
Background:
- Bicuspid aortic valves (BAV) are linked to serious aortic complications, including dissection.
- Associated aortic dilatation requires careful management alongside BAV repair.
Purpose of the Study:
- To determine if proactive repair of aortic dilatation with BAV surgery reduces dissection or reoperation risk.
- To assess if more aggressive resection is necessary in patients undergoing BAV surgery alone.
Main Methods:
- Analysis of long-term outcomes for 1810 patients undergoing BAV surgery between 1993 and 2003.
- Comparison of outcomes based on aortic size and whether BAV surgery was performed alone or with aortic repair.
Main Results:
- In-hospital survival was similar for BAV surgery alone versus with aortic repair (98.8% vs 98.9%).
- Late survival was better with concomitant aortic repair (85% vs 75% at 10 years), and similar in matched cohorts (86% vs 85%).
- Freedom from late aortic events was high and similar in both groups (97-99%).
Conclusions:
- Concurrent aortic repair is recommended for aortic diameters >4.5 cm or area/height ratios >8-10, as it carries no added risk and improves late survival.
- More aggressive aortic resection beyond these parameters is not supported by the data.
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