title: Replacement of the proximal aorta adds no further risk to aortic valve procedures.
abstract: BACKGROUND
  Aortic valve pathology is often associated with proximal aortic dilatation. Even after valve surgery, the proximal aorta can continue to dilate and thus be at risk for rupture, dissection, or later aortic replacement. We hypothesized that the addition of proximal aortic intervention adds no further risk to aortic valve surgery, which may avoid subsequent proximal aortic procedures or catastrophes.
  
  
  METHODS
  Between 1996 and 2004, 430 aortic valve interventions alone and 146 aortic valves with proximal aortic replacements were identified in elective adult patients. The age in the valve-alone patients (68.8 years) was slightly higher than the valve-plus-aorta group (valve/aorta, 60.5 years; p < 0.01), but comorbidities were similar between groups. We compared groups based on hospital mortality and incidence of complications.
  
  
  RESULTS
  The 30-day mortality was similar between groups (valve-alone, 3.8% versus valve/aorta, 2.7%; p = 0.5), as were rates for bleeding and operative revision (valve-alone, 6.7% versus valve/aorta, 9.5%; p = 0.5). Pulmonary (valve-alone, 23.0% versus valve/aorta, 11.6%) and renal complications (valve-alone, 8.2% versus valve/aorta, 2.7%) were higher in the valve-alone group (p = 0.02). Logistic regression demonstrated no additional risk of death, neurologic, or cardiac event with replacement of the proximal aorta.
  
  
  CONCLUSIONS
  Proximal aortic replacement adds no risk to the patient beyond the aortic valve intervention alone. These findings suggest proximal aortic replacement is safe for patients undergoing valve operations. Patients with a moderately enlarged proximal aorta that may dilate further should also be considered for aortic replacement at the time of valve procedures.
authors.affiliation: Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
authors.forename: R Ramesh
authors.initials: RR
authors.lastname: Singh
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Tribble
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D015897:Comorbidity; D001026:Coronary Artery Bypass; D006331:Heart Diseases / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D016019:Survival Analysis