title: Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement.
abstract: OBJECTIVE
  The optimal management of dilated ascending aorta during aortic valve replacement (AVR) remains controversial. This study compared the outcomes among 3 different managements (AVR alone, aorta wrapping, and aorta replacement) for the dilated ascending aorta.
  
  
  METHODS
  The study enrolled 499 consecutive non-Marfan patients undergoing AVR in the presence of the ascending aorta dilatation (40 to 55 mm). We evaluated rates of death and aortic events; in addition, we evaluated the aortic expansion rate by serial echocardiography.
  
  
  RESULTS
  The surgery involved AVR alone (n = 362), aorta wrapping (n = 67), or aorta replacement (n = 70). Early mortality occurred in 1.2% (n = 6, P = .61). Throughout 1590.0 patient-years of follow-up, 47 deaths occurred. The 5-year survival rates were 90.1% ± 2.0%, 91.8% ± 3.5%, and 82.2% ± 7.5% in the AVR alone, aorta wrapping, and aorta replacement groups, respectively (P = .64). One aortic event (acute type A dissection) occurred in the AVR alone group. For the AVR alone group, the median aortic expansion rate was -0.6 mm/y (interquartile range, -3.2 to 0.6 mm/y). The aortic expansion rates were affected neither by the morphology of aortic valves (bicuspid vs tricuspid; P = .10) nor by the initial aorta diameter (γ = -0.31, P = .61). Clinically relevant aortic expansion (≥5 mm/y) was observed only in 5 patients; of these patients, 2 showed the aortic diameter of 60 mm or greater at the end of follow-up.
  
  
  CONCLUSIONS
  Compared with concomitant aortic wrapping or replacement, AVR alone achieved similar clinical outcomes, showing considerably low risks of adverse aortic events or relevant aortic expansion in dilated ascending aorta. These findings argue against routine aortic replacement at the time of AVR.
authors.affiliation: Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.forename: Dong Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 26.1.3; 35.2; AVR; BAV; CT; IQR; LV; TAV; aortic valve replacement; bicuspid aortic valve; computed tomographic; interquartile range; left ventricular; tricuspid aortic valve