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[Dissection of the ascending aorta after aortic valve replacement]
Presse Medicale (Paris, France : 1983)
|October 20, 1984
Summary
Aortic valve replacement can lead to acute aortic dissection, a rare but serious complication. Surgeons should consider prophylactic replacement of fragile, dilated ascending aortas to prevent this risk.
Area of Science:
- Cardiovascular Surgery
- Aortic Pathology
Background:
- 1117 aortic valve replacements were performed between 1969 and 1982.
- A rare complication of acute aortic dissection following aortic valve replacement was observed.
Observation:
- Five cases (0.4%) of acute ascending aortic dissection occurred 6 months to 6 years post-surgery.
- Histological examination revealed cystic medial necrosis in all affected aortas.
- Intraoperative findings consistently noted dilated or fragile aortas.
Findings:
- Acute aortic dissection is a potential complication after aortic valve replacement.
- Cystic medial necrosis and aortic fragility are associated risk factors.
- Emergency prosthetic replacement of the ascending aorta is a viable treatment.
Implications:
- Systematic prophylactic replacement of fragile, dilated ascending aortas (>5 cm diameter) warrants consideration.
- Further research into the etiology and prevention of post-aortic valve replacement aortic dissection is needed.
- Improved diagnostic and therapeutic strategies may reduce mortality and morbidity.