title: Dilatation of the remaining aorta after aortic valve or aortic root replacement in patients with bicuspid aortic valve: a 5-year follow-up.
abstract: BACKGROUND
  The natural history and management of ascending aorta (AA) and arch dilatation in patients with bicuspid aortic valve (BAV) after aortic valve replacement (AVR) or aortic root replacement (ARR) remains controversial. Our aim is to identify dilatation of the remaining aorta after AVR or ARR in patients with BAV compared with patients with tricuspid aortic valve (TAV).
  
  
  METHODS
  Three hundred ninety-five patients who underwent AVR or ARR between 2002 and 2009 were studied. Preoperative computed tomography (CT) and echocardiography were performed in 192 patients with BAV, and the results were compared with those of 203 patients with TAV. An AA diameter 4.5 cm or greater was regarded as aneurysmal. Postoperative echocardiograms, computed tomographic scans, and magnetic resonance images were compared with subsequent imaging at a median follow-up of 4.6 years (2.2-9.8 years).
  
  
  RESULTS
  Median ages of patients with BAV and patients with TAV were 57 ± 14 and 65 ± 16 years, respectively (p < 0.05). Preoperative diameter of AA in the BAV group with no aneurysm (3.5 cm; range, 3.0-4.0 cm; n = 143) was significantly higher than in the TAV group (3.3 cm; range, 3.1-3.8 cm; n = 129) (p < 0.001). In both BAV and TAV groups with nonaneurysmal aortas who underwent AVR, there was no significant expansion of the AA and arch at 5 years' follow-up. In patients with aneurysmal aorta (BAV group, n = 49; TAV group, n = 74) who underwent ARR, there was also no significant difference in growth of the remaining aorta at 3 and 5 years' follow-up.
  
  
  CONCLUSIONS
  No significant dilatation of the AA or arch was observed after AVR or ARR, respectively, in patients when a cut-off diameter of 4.5 cm or greater was considered for replacement in patients with BAV compared with patients with TAV up to 5 years after operation. The need for aortic replacement at smaller diameters was not found.
authors.affiliation: Department of Cardiothoracic Surgery, St. George's Hospital, University of London, London, United Kingdom.
authors.forename: Nada
authors.initials: N
authors.lastname: Abdulkareem
authors.forename: Gopal
authors.initials: G
authors.lastname: Soppa
authors.forename: Siôn
authors.initials: S
authors.lastname: Jones
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Valencia
authors.forename: Jeremy
authors.initials: J
authors.lastname: Smelt
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome