Aortic complications after bicuspid aortic valve replacement: long-term results.
BACKGROUND
Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR).


METHODS
One hundred consecutive patients were allocated into two groups according to the presence of BAV (group A, 50 patients) or TAV (group B, 50 patients). Mean age was 51 +/- 12 years in group A, and 50 +/- years 12 in group B. No patients had hypertension or Marfan's syndrome. Until July 2001, mean follow-up was 234 +/- 47 months in group A and 241 +/- 43 months in group B.


RESULTS
Five patients (10%, CL 5.7 to 13.9) in group A suffered late acute aortic dissection. Acute aortic dissection (5 vs 0, p = 0.0001) and sudden death (7 vs 0, p = 0.0001) occurred more frequently in patients with BAV. All survivors were assessed by echocardiogram. The mean diameter of the ascending aorta was 48.4 mm in group A and 36.8 mm in group B. Three patients in group A were operated on because of ascending aorta aneurysm more than 6 cm in diameter.


CONCLUSIONS
As a result of our experience, we recommend a policy of prophylactic replacement of even a seemingly normal and definitely a mildly enlarged ascending aorta in cases of BAV at the moment of AVR, and consideration of a similar approach for any other cardiac surgical procedure in patients with BAV.
Russo
Claudio F
CF
Division of Cardiovascular Surgery, Niguarda Hospital, Milan, Italy. f.russo@tiscali.it
Mazzetti
Simone
S
Garatti
Andrea
A
Ribera
Elena
E
Milazzo
Angela
A
Bruschi
Giuseppe
G
Lanfranconi
Marco
M
Colombo
Tiziano
T
Vitali
Ettore
E
D000208:Acute Disease; D000784:Aortic Dissection / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate