Ectasia of the ascending aorta at the time of aortic valve surgery: replace or relax?
BACKGROUND
The fate of aortic ectasia associated with aortic valve disease is usually derived from the natural history of primitive aortic aneurysm. We evaluated the evolution of untreated aortic dilation following aortic valve replacement and analyzed risk factors for expansion.


METHODS
Thirty-eight patients undergoing aortic valve replacement, with an aortic diameter 40 to 55 mm, were followed up for a mean of 42 +/- 28 months (median 36 months). Freedom from adverse events, velocity of aortic expansion and correlation between velocity and several potential risk factors were evaluated.


RESULTS
The mean aortic diameter did not change over time (43 +/- 4 vs 44 +/- 12, p = NS). Velocity of aortic expansion correlated significantly with the diameter of the ascending aorta at the time of operation, with faster growth in patients with ascending aorta diameter > 50 mm (p = 0.0004). Patients with aortic regurgitation had a tendency to a faster aortic dilation compared to those with aortic stenosis (p = 0.10). CONCLUSIONS. In patients without other risk factors, prophylactic surgical treatment of the ectasic aorta seems advisable for diameters > 48 mm. For diameters < 43 mm no treatment is probably needed. Other aspects must be considered for appropriate surgical strategy in the interval between 43 and 48 mm. Patients with aortic regurgitation should be closely monitored.
Bassano
Carlo
C
Department of Cardiac Surgery, "Tor Vergata" University, Rome, Italy. carlo.bassano@fastwebnet.it
Fratticci
Laura
L
Del Giudice
Costantino
C
Andò
Giuseppe
G
De Paulis
Ruggero
R
Nardi
Paolo
P
El Fakhri
Fadi
F
Chiariello
Luigi
L
D000368:Aged; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000473:pathology; D005260:Female; D006349:Heart Valve Diseases / Q000473:pathology* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors