title: Long-term prognosis of ascending aortic aneurysm after aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis.
abstract: OBJECTIVE
  The bicuspid aorta is thought to have a higher risk of progressive dilation after aortic valve replacement with a subsequently increased risk of adverse aortic events. Our aim was to compare the risk of late aortic events after isolated aortic valve replacement surgery for bicuspid versus tricuspid aortic valve stenosis with concomitant mild to moderate dilatation of the proximal aorta.
  
  
  METHODS
  A total of 325 consecutive patients (60% males; mean age, 59.5 ± 10 years) with aortic valve stenosis and concomitant ascending aortic dilatation of 40 to 50 mm underwent isolated aortic valve replacement from 1995 through 2000. A total of 153 patients (47%) were diagnosed with bicuspid aortic valve stenosis (bicuspid aortic valve group), whereas the remaining 172 patients (53%) had tricuspid aortic valve stenosis (tricuspid aortic valve group). Follow-up (3566 patient-years) was 100% complete. Adverse aortic events were defined as the need for proximal aortic surgery or the occurrence of aortic dissection/rupture or sudden death during follow-up.
  
  
  RESULTS
  Overall survival was 78 ± 4% in the bicuspid aortic valve group versus 55 ± 6% in the tricuspid aortic valve group (P = .006) at 15 years postoperatively, but age-adjusted survival was not significantly different between groups (P = .4). A total of 5 patients (3%) in the bicuspid aortic valve group versus 9 patients (5%) in the tricuspid aortic valve group underwent proximal aortic surgery during follow-up. Aortic dissection occurred in 3 patients in the tricuspid aortic valve group and in no bicuspid aortic valve patients. Fifteen-year freedom from adverse aortic events was 93 ± 3% in the bicuspid aortic valve group versus 82 ± 6% in the tricuspid aortic valve group (P = .2).
  
  
  CONCLUSIONS
  Patients with bicuspid and tricuspid aortic valve stenosis with concomitant mild to moderate ascending aortic dilatation are at comparably low risk of adverse aortic events 15 years after isolated aortic valve replacement.
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany. Electronic address: evagird@centras.lt.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Girdauskas
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Kushtrim
authors.initials: K
authors.lastname: Disha
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D018450:Disease Progression; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult