Aortic valve morphology determines the presentation and surgical approach to acute type A aortic dissection

Data on acute type A aortic dissection in patients with bicuspid aortic valve (BAV) syndrome are limited. This investigation evaluated the clinical details in patients with type A dissection stratified according to aortic valve morphology.

Between 1993 and 2013, 629 patients (median age 61 years [50; 73], 64% men) underwent surgical procedures for type A dissection. Forty-one patients with BAV were compared with 588 patients with tricuspid aortic valve (TAV).

The BAV patients were younger (55 years [46; 67] vs 61 years [51; 73] years; p < 0.001), presented more frequently with moderate or severe aortic insufficiency (51% vs 34%; p = 0.039), cardiogenic shock (37 vs 21%; p = 0.029), and had larger ascending aorta diameters (5.5 cm [5.1; 6.4] vs 4.8 cm [4.4; 5.5] cm; p < 0.001). The BAV patients more frequently required aortic root replacement (81% vs 14%; p < 0.001). Total arch replacement was performed in 5% of the BAV patients and 4% of the TAV patients. In-hospital mortality (14.6% vs 13.1%; p = 1.0) and survival at 5, 10, and 15 years (56% ± 8%, 46% ± 10%, and 37% ± 11% vs 68% ± 2%, 49% ± 3%, and 36% ± 4%; log rank, p = 0.4) were similar in the BAV and TAV patients. Twenty (3%) TAV and no BAV patients underwent proximal reoperations (p = 0.6) at a median follow-up time of 4.1 years (range, 0.8 to 6.9 years).

BAV patients experience dissection at a younger age and at a greater ascending aortic diameter. Extensive aortic root repair in BAV patients is not associated with higher in-hospital mortality and prevents the need for later proximal redo operation.