title: The influence of operative techniques on the outcomes of bicuspid aortic valve disease and aortic dilatation.
abstract: BACKGROUND
  Bicuspid aortic valve is associated with aortic aneurysm formation that may extend beyond the ascending aorta.
  
  
  METHODS
  Between 1979 and 1997, 143 bicuspid aortic valve patients had aortic valve operations with replacement of an aneurysmal ascending aorta: 93 (65%) underwent full root replacement and 50 (35%) underwent separate valve and graft replacement. Distal aortic anastomosis was open in 42 patients (29%) and closed in 101 (71%). Late survival and complications were compared by surgical technique.
  
  
  RESULTS
  Patients undergoing full root replacement tended to be younger (mean age 46 +/- 16 vs 59 +/- 13, p < 0.001) and presented with more aortic insufficiency (80% vs 35%, p < 0.001). Three (2.1%) hospital deaths occurred. Event-free survival was 82% (95% confidence interval, 75% to 88%) at 10 years and 41% (95% confidence interval, 11% to 71%) at 20 years. At a median follow-up of 11.5 years, the incidence of new aneurysms and late aortic complications were not significantly different among the procedure groups. Age at the time of operation was the only predictor of late survival (hazard ratio, 1.07; p = 0.007).
  
  
  CONCLUSIONS
  Aortic root replacement with distal aortic reconstruction can be achieved with very low operative mortality and excellent long-term outcomes in patients with bicuspid aortic valve and dilated ascending aorta. The type of surgical procedure done in the aortic root and in the distal ascending aorta does not influence late survival, subsequent operation, or aortic complications. This is likely influenced by our patient-specific strategy when replacing the aortic root and distal ascending aorta.
authors.affiliation: Division of Cardiovascular Surgery of Toronto General Hospital, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada. rakan.nazer@utoronto.ca
authors.forename: Rakan I
authors.initials: RI
authors.lastname: Nazer
authors.forename: Abdelsalam M
authors.initials: AM
authors.lastname: Elhenawy
authors.forename: Shafie S
authors.initials: SS
authors.lastname: Fazel
authors.forename: Luis E
authors.initials: LE
authors.lastname: Garrido-Olivares
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
mesh_terms: D001014:Aortic Aneurysm / Q000150:complications* / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome