title: Acute type A aortic dissection: characteristics and outcomes comparing patients with bicuspid versus tricuspid aortic valve.
abstract: OBJECTIVE
  The aim of this study is to investigate the clinical characteristics and postoperative outcome of patients with a bicuspid aortic valve (BAV) suffering acute dissection in comparison with their tricuspid peers.
  
  
  METHODS
  Between 1995 and 2011, 460 consecutive patients underwent emergency repair for acute type A aortic dissection. In 379 patients without connective tissue disease, the aortic valve morphology could clearly be specified (91.6% tricuspid and 8.4% bicuspid).
  
  
  RESULTS
  At the time of dissection, patients with a bicuspid valve were younger (46.7 ± 13 vs 61.6 ± 12 years, P < 0.001) with the entry tear more often located in the root compared with those with a tricuspid valve (bicuspid: 31.3% vs tricuspid: 6.3%, P < 0.001). Consequently, surgical repair warranted root replacement in 93.8% of bicuspid vs 28.8% of tricuspid valve patients (P < 0.001). The leading pathology was medial necrosis/degeneration in bicuspid and atherosclerosis in tricuspid patients (P = 0.166). Hospital mortality was 20.3% and not significantly different between the two valve morphologies, even despite the younger age of bicuspid patients: 28.1% among bicuspids vs 19.6% among tricuspids (P = 0.255). Survival after discharge was 63.3% at 10 years for all patients. BAV patients had a significantly better survival with 100% at 10 years compared with 60.2% in tricuspid valve patients (P = 0.011). Mean follow-up among survivors was comparable for bicuspid and tricuspid patients (3.7 and 4.1 years, respectively).
  
  
  CONCLUSIONS
  Patients with BAV have a distinctive dissection pattern with the entry tear frequently located in the aortic root and-despite their younger age-are subject to substantial hospital mortality. For bicuspid patients suffering from dissection, composite root replacement yields an excellent outcome equal to an age- and gender-matched normal population.
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany konstantin.aspern@herzzentrum-leipzig.de.
authors.forename: Konstantin
authors.initials: K
authors.lastname: von Aspern
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Alexandro
authors.initials: A
authors.lastname: Hoyer
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Felix F
authors.initials: FF
authors.lastname: Girrbach
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Sergey
authors.initials: S
authors.lastname: Leontyev
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*
keywords: Acute aortic dissection; Bicuspid aortic valve; Stanford type A