title: Midterm results of different surgical techniques to replace dilated ascending aorta associated with bicuspid aortic valve disease.
abstract: BACKGROUND
  This study evaluated effectiveness of three different surgical strategies for treating ascending aorta aneurysm, with or without involvement of the aortic root, associated with bicuspid aortic valve (BAV).
  
  
  METHODS
  Between 2005 and 2011, 150 consecutive patients underwent a Bentall operation in the presence of ascending aorta and aortic root dilation exceeding 45 mm in diameter and malfunctioning BAV (n = 46, group 1); separate aortic valve and ascending aorta replacement in presence of ascending aorta dilation exceeding 45 mm, aortic root of less than 45 mm, and malfunctioning BAV (n = 77, group 2); or ascending aorta replacement, with or without BAV repair, in the presence of ascending aorta dilation exceeding 45 mm, aortic root of less than 45 mm, and normally functioning or mildly insufficient BAV (n = 27, group 3).
  
  
  RESULTS
  Compared with groups 2 and 3, group 1 patients were younger and affected by more severe BAV insufficiency and worse left ventricular function. In groups 1, 2, and 3, respectively, operative mortality was 2.1%, 1.3%, and 0%, and 5-year survival was 94% ± 4%, 92% ± 3.4%, and 100%. At 5 years, no patient in any group required reoperation on the ascending aorta or experienced aortic complications. In groups 2 and 3, root dimensions did not increase and were also significantly smaller compared with preoperative measurements (p < 0.05). Aortic regurgitation grade in group 3 (0.5 ± 0.8/4+) did not increase compared with the preoperative grade (0.8 ± 0.9/4+).
  
  
  CONCLUSIONS
  At midterm follow-up, the Bentall operation remains associated with optimal results for the treatment of BAV, despite a worse preoperative presentation. In presence of a mildly diseased or normal aortic root and normal BAV function at the time of operation, less invasive surgical procedures, BAV-sparing, or repair procedures, appear to offer gratifying results.
authors.affiliation: Department of Cardiac Surgery, Tor Vergata University of Rome, Policlinic, Rome, Italy. Electronic address: pa.nardi4@libero.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Pellegrino
authors.forename: Marco
authors.initials: M
authors.lastname: Russo
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Saitto
authors.forename: Fabio
authors.initials: F
authors.lastname: Bertoldo
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D006348:Cardiac Surgical Procedures / Q000379:methods; D004108:Dilatation, Pathologic / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: 26