Aortic complications after aortic valve replacement in patients with dilated ascending aorta and aortic regurgitation

Postoperative aortic complications of aortic dissection or enlargement of the ascending aortic develop in patients with aortic valve replacement (AVR) and dilated ascending aorta. This clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with dilated ascending aorta, and to clarify the surgical indication and approach for dilated ascending aorta and aortic regurgitation.

A total of 82 patients who underwent AVR between 1985 and 1997 were allocated to two groups according to the preoperative diameter of the ascending aorta. A dilated ascending aorta with diameter > or = 40 mm was seen in 38 patients (group I), and a small ascending aorta with diameter < 39 mm in 44 patients (group II). Group I patients were further allocated to two subgroups: 12 patients underwent aortoplasty (group IA) and 26 did not (group IB). Event-free rates of aortic complications and survival rate were compared between groups I and II.

Postoperative aortic dissection during the follow up period occurred in four hypertensive patients in group I (one in group IA, three in group IB); no aortic dissection was seen in group II. Freedom from all aortic complications at 10 years after surgery was 75 +/- 10% in group I and 100% in group II (p < 0.05). The cumulative survival rate at 10 years was 59 +/- 11% in group I (group IA: 71 +/- 18%, group IB: 51 +/- 14%) and 95 +/- 4% in group II (p < 0.05).

Patients with a dilated ascending aorta (> or = 40 mm diameter) were more likely to encounter complications of the aortic dissection or enlargement after AVR than those with a small ascending aorta. Surgery to prevent aortic dissection or enlargement must be selected in patients with mildly dilated ascending aorta and hypertension.