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Ascending aorta dissection after aortic valve replacement

A Milano1, S Pratali, M De Carlo

  • 1Department of Cardiac Surgery, University of Pisa Medical School, Italy.

The Journal of Heart Valve Disease
|March 21, 1998
PubMed
Summary
This summary is machine-generated.

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Aortic valve replacement alone may not prevent ascending aortic enlargement in patients with existing dilatation. Concomitant replacement of the ascending aorta is recommended for those with significant dilation to prevent dissection.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Surgical management of aortic valve disease with ascending aortic dilatation remains controversial.
  • Aortic wall abnormalities increase risk of enlargement and ascending aortic dissection (AAD).
  • Clear indications for combined aortic valve and ascending aorta replacement are lacking.

Purpose of the Study:

  • To evaluate the outcomes of aortic valve replacement (AVR) in patients who subsequently developed ascending aortic dissection (AAD).
  • To determine appropriate surgical strategies for patients with aortic valve disease and ascending aortic dilatation.

Main Methods:

  • Retrospective review of eight patients who underwent AVR and later reoperation for AAD between 1982 and 1996.
  • Analysis of indications for initial AVR, interval to AAD, and aortic dimensions at reoperation.

Related Experiment Videos

  • Histological examination of aortic wall structure in affected patients.

    • Main Results:

    • The interval between AVR and AAD varied from 4 months to 10.5 years.
    • Four patients showed progressive aortic enlargement post-AVR, with a mean diameter of 72+/-9 mm at reoperation.
    • Hospital mortality was 13%, with no late deaths or major adverse events during follow-up.

    Conclusions:

    • AVR alone may be insufficient to prevent aortic root enlargement in patients with ascending aortic dilatation (≥ 55 mm).
    • Concomitant replacement of the ascending aorta is advised for these patients.
    • Post-AVR surveillance for aortic root dilatation progression is crucial for patients with mild to moderate dilation.