Predictors of proximal aortic dissection at the time of aortic valve replacement.
BACKGROUND
Type I aortic dissection develops in 0.6% of patients late after aortic valve replacement (AVR), and 13% of patients with type I aortic dissections have a history of AVR. Predictors of aortic dissection at AVR, however, have not been characterized.


RESULTS
A study group of 33 patients with type I aortic dissection had aortic surgery 49+/-55 months after routine AVR. A group of 101 controls, who did not have morphological progression of aortic diameters >/=6 years after AVR, was used to identify predictors of postsurgical dissection. Multivariate analysis identified aortic regurgitation (P<0.002) and fragility (P<0.001) or thinning of the aortic wall (P<0.007) at AVR as predictors, associated with a 14%, 22%, and 7% probability of late aortic dissection, respectively. Clamping times, types of valve prostheses, concomitant coronary artery bypass grafting, and mean ascending aortic diameters of 43+/-10 mm at AVR did not predict late dissection. A separate analysis of 29 nondissecting aneurysms of the ascending aorta developing 104+/-64 months after routine AVR revealed younger age at AVR (P<0.003) and congenitally bicuspid aortic valves (P<0.03) as predictors of late aneurysm formation.


CONCLUSIONS
Aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation may reflect aortic root disease, with a high risk for postsurgical aortic sequelae if it is treated incompletely by isolated valve replacement.
von Kodolitsch
Y
Y
Department of Internal Medicine, Division of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
Simic
O
O
Schwartz
A
A
Dresler
C
C
Loose
R
R
Staudt
M
M
Ostermeyer
J
J
Haverich
A
A
Nienaber
C A
CA
D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm; D001018:Aortic Diseases / Q000150:complications* / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors