title: Late outcome of noncoronary sinus replacement in patients with bicuspid aortic valves and aortopathy.
abstract: BACKGROUND
  Aortopathy associated with bicuspid aortic valve commonly involves the ascending aorta above the sinotubular ridge, but it may also affect sinus portions of the aorta. In some persons, the enlarged portion of the aortic root is limited to the noncoronary sinus. In such patients, we have spared the remaining portions of the aortic root by replacing the ascending aorta with a polyethylene terephthalate fiber (Dacron) graft and a tongue-shaped extension of the graft, thereby replacing the noncoronary sinus. In the present study, we evaluated late outcomes of this procedure, with specific attention to the fate of aortic tissue in the remaining sinuses.
  
  
  METHODS
  We reviewed the medical records of 1,756 patients with repair of ascending aortic aneurysms at Mayo Clinic from 1993 through 2012. Among the patients, 631 (35.9%) had bicuspid aortic valve, and in 79 (4.5%) of the patients, the noncoronary sinus was replaced along with the ascending aorta.
  
  
  RESULTS
  Associated aortic valve operations were performed in 70 patients; 15 had repair and 55 had aortic valve replacement. No early death occurred, but 3 patients died late after operation (5-year survival, 99%). There were 3 late reoperations, all because of native or prosthetic valve problems. Importantly, no instances occurred of aneurysm formation or aortic dissection related to the remaining aorta in the left and right aortic sinuses.
  
  
  CONCLUSIONS
  In patients with bicuspid aortic valve and aortic root enlargement related mainly to enlargement of the noncoronary sinus, limited replacement of the noncoronary sinus and ascending aorta is a safe and simple procedure that is durable in midterm follow-up.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Murat
authors: M
authors: Ugur
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: schaff@mayo.edu.
authors: Hartzell V
authors: HV
authors: Schaff
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Rakesh M
authors: RM
authors: Suri
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Joseph A
authors: JA
authors: Dearani
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Lyle D
authors: LD
authors: Joyce
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Heidi M
authors: HM
authors: Connolly
mesh_terms: D000369:Aged, 80 and over; 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; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome