title: Ectasia of the ascending aorta at the time of aortic valve surgery: replace or relax?
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, "Tor Vergata" University, Rome, Italy. carlo.bassano@fastwebnet.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Bassano
authors.forename: Laura
authors.initials: L
authors.lastname: Fratticci
authors.forename: Costantino
authors.initials: C
authors.lastname: Del Giudice
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andò
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
authors.forename: Paolo
authors.initials: P
authors.lastname: Nardi
authors.forename: Fadi
authors.initials: F
authors.lastname: El Fakhri
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
mesh_terms: 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