title: Natural history of a dilated ascending aorta after aortic valve replacement.
abstract: BACKGROUND
  Little information is available regarding the incidence of aortic dissection or rupture in patients with a dilated ascending aorta after aortic valve replacement (AVR). The present clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with a dilated ascending aorta and to clarify those risk factors associated with the progression of a dilated ascending aorta or late aortic events.
  
  
  RESULTS
  A total of 35 patients with a dilated ascending aorta at the time of AVR were enrolled. A dilated ascending aorta was defined as 40 mm or greater in diameter by preoperative computed tomography or operative findings. The baseline ascending aorta diameter ranged from 40 to 55 mm with a mean of 44.8+/-4.4 mm. There was a high frequency of bicuspid valve disease in patients with a dilated ascending aorta (57%). The mean follow-up interval was 8.1+/-3.5 years (range: 2.3-13). Aortic events occurred in 5 patients (aortic dissection in 1, rupture in 2, reoperation in 2) during the follow-up. One aortic dissection developed at a baseline aortic size of 42 mm, whereas 2 aortic ruptures occurred at baseline aortic sizes of 47 mm and 50 mm. There was no statistically significant univariate association between any of the patient clinical characteristics and late aortic events or ascending aortic progression.
  
  
  CONCLUSIONS
  Although the clinical course of patients with a dilated ascending aorta is unpredictable, aortic events may occur even in patients with a baseline aortic diameter of <50 mm. Therefore, preventive aortic surgery at the time of AVR should be considered to prevent aortic dissection or rupture in patients with an even slightly dilated ascending aorta with a diameter of 40 to 50 mm, unless the patient has a high operative risk or older age.
authors.affiliation: Nagoya University Graduate School of Medicine, Department of Cardio-Thoracic Surgery, Nagoya, Japan. k-matsuy@f3.dion.ne.jp
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Matsuyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Akita
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Masaomi
authors.initials: M
authors.lastname: Murayama
authors.forename: Takashi
authors.initials: T
authors.lastname: Yano
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Takenaka
authors.forename: Wataru
authors.initials: W
authors.lastname: Katou
authors.forename: Masashi
authors.initials: M
authors.lastname: Toyama
authors.forename: Masaho
authors.initials: M
authors.lastname: Okada
authors.forename: Motonari
authors.initials: M
authors.lastname: Sawaki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology; D001011:Aorta; D001014:Aortic Aneurysm / Q000209:etiology; D001019:Aortic Rupture / Q000209:etiology; D001021:Aortic Valve; D004108:Dilatation, Pathologic / Q000150:complications* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed