title: Comparison of aortic media changes in patients with bicuspid aortic valve stenosis versus bicuspid valve insufficiency and proximal aortic aneurysm.
abstract: OBJECTIVE
  The aim of this study was to evaluate aortic media changes in bicuspid aortic valve (BAV) patients who underwent aortic valve replacement (AVR) and simultaneous replacement of the proximal aorta for BAV stenosis vs BAV insufficiency.
  
  
  METHODS
  Review of our institutional BAV database identified a subgroup of 79 consecutive BAV patients (mean age 52.3 ± 13 years, 81% men) with BAV stenosis or insufficiency and concomitant proximal aortic dilatation of ≥50 mm who underwent AVR and simultaneous replacement of proximal aorta from 1995 through 2005. All cases of BAV disease and concomitant ascending aortic dilatation of 40-50 mm underwent isolated AVR and therefore were excluded from this analysis. Proximal aortic media elastic fibre loss (EFL) was assessed (graded 0 to 3+) and compared between patients with BAV stenosis (Group I, n = 44) vs BAV insufficiency (Group II, n = 35). Follow-up (690 patient-years) was 100% complete and 9.1 ± 4.6 years long.
  
  
  RESULTS
  Mean aortic media EFL was 1.3 ± 0.7 in Group I vs 2.5 ± 0.8 in Group II (P = 0.03). Moderate/severe EFL (i.e. defined as grade 2+/3+) was found in 13 patients (29%) in Group I vs 28 patients (80%) in Group II (P < 0.001). Logistic regression identified BAV insufficiency as the strongest predictor of moderate/severe EFL (OR 9.3; 95% CI 3.2-29.8, P < 0.001). Valve-related event-free survival was 64 ± 8% in Group I vs 93% ± 5% in Group II at 10 years postoperatively (P = 0.05). A total of 4 patients (5%, 3 from Group I and 1 from Group II) underwent redo aortic root surgery for prosthetic valve endocarditis during follow-up.
  
  
  CONCLUSIONS
  Patients with BAV insufficiency and a proximal aorta of ≥50 mm have a significantly higher rate of moderate/severe EFL as compared to their counterparts with BAV stenosis.
authors.affiliation: Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Girdauskas
authors.forename: Mina
authors.initials: M
authors.lastname: Rouman
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation; D018572:Disease-Free Survival; D004547:Elastic Tissue / Q000473:pathology; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D017540:Tunica Media / Q000473:pathology* / Q000601:surgery
keywords: Aorta; Aortic complication; Bicuspid aortic valve