Aortic valve morphology determines the presentation and surgical approach to acute type A aortic dissection.
BACKGROUND
Data on acute type A aortic dissection in patients with bicuspid aortic valve (BAV) syndrome are limited. This investigation evaluated the clinical details in patients with type A dissection stratified according to aortic valve morphology.


METHODS
Between 1993 and 2013, 629 patients (median age 61 years [50; 73], 64% men) underwent surgical procedures for type A dissection. Forty-one patients with BAV were compared with 588 patients with tricuspid aortic valve (TAV).


RESULTS
The BAV patients were younger (55 years [46; 67] vs 61 years [51; 73] years; p < 0.001), presented more frequently with moderate or severe aortic insufficiency (51% vs 34%; p = 0.039), cardiogenic shock (37 vs 21%; p = 0.029), and had larger ascending aorta diameters (5.5 cm [5.1; 6.4] vs 4.8 cm [4.4; 5.5] cm; p < 0.001). The BAV patients more frequently required aortic root replacement (81% vs 14%; p < 0.001). Total arch replacement was performed in 5% of the BAV patients and 4% of the TAV patients. In-hospital mortality (14.6% vs 13.1%; p = 1.0) and survival at 5, 10, and 15 years (56% ± 8%, 46% ± 10%, and 37% ± 11% vs 68% ± 2%, 49% ± 3%, and 36% ± 4%; log rank, p = 0.4) were similar in the BAV and TAV patients. Twenty (3%) TAV and no BAV patients underwent proximal reoperations (p = 0.6) at a median follow-up time of 4.1 years (range, 0.8 to 6.9 years).


CONCLUSIONS
BAV patients experience dissection at a younger age and at a greater ascending aortic diameter. Extensive aortic root repair in BAV patients is not associated with higher in-hospital mortality and prevents the need for later proximal redo operation.
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Heart Center Freiburg University, Freiburg, Germany. Electronic address: bartosz.rylski@universitaets-herzzentrum.de.
Bartosz
B
Rylski
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Nimesh D
ND
Desai
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Joseph E
JE
Bavaria
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Prashanth
P
Vallabhajosyula
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
William
W
Moser
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Alberto
A
Pochettino
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Wilson Y
WY
Szeto
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Rita K
RK
Milewski
D000208:Acute Disease; D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged