Related Experiment Video
Updated: May 7, 2026
12:17
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
11.3K
Long-term outcomes after aortic root replacement for bicuspid aortic valve-associated aneurysm
Kavya Rajesh1, Megan Chung1, Dov Levine1
1Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY.
Summary
Patients undergoing aortic root replacement for bicuspid aortic valve (BAV) have a 35% reoperation rate at 15 years. However, their long-term survival is comparable to the general US population, indicating good outcomes after BAV repair.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Congenital bicuspid aortic valve (BAV) is a common condition often necessitating aortic root replacement due to aneurysm formation.
- Long-term outcomes, including mortality and reoperation rates, following aortic root replacement in BAV patients are critical for clinical management.
Purpose of the Study:
- To evaluate the long-term mortality and reoperation rates in patients with bicuspid aortic valve who underwent aortic root replacement.
- To identify factors associated with long-term mortality in this specific patient cohort.
Main Methods:
- A multicenter retrospective study involving 747 patients with BAV undergoing aortic root replacement between 2004 and 2020.
- Utilized cumulative incidence curves for reoperations and Kaplan-Meier survival analysis, comparing the cohort to the general US population.
- Employed multivariable Cox regression to identify predictors of long-term mortality.
Main Results:
- The study included 747 patients (13.5% female), with a median age of 54 years. Common BAV dysfunctions included aortic insufficiency (36.7%) and stenosis (25.0%).
- In-hospital mortality was low (1.3%). At 15 years, the cumulative incidence of aortic valve or aortic reoperations was 35%.
- Survival was comparable to the age- and sex-matched US population. Increased mortality was associated with older age, concomitant coronary artery bypass grafting (CABG), and longer bypass times.
Conclusions:
- Aortic root replacement in patients with bicuspid aortic valve is associated with a significant rate of reoperation (35% at 15 years).
- Despite reoperation rates, long-term survival for these patients is comparable to the general US population.
- Age, concomitant CABG, and bypass duration are key factors influencing long-term mortality in BAV patients undergoing aortic root replacement.
Related Concept Videos
01:15Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:17Aortic Regurgitation IV: Nursing Management
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...