title: Bicuspid Aortic Valve Resuspension in Acute Type A Aortic Dissection Patients.
abstract: BACKGROUND
  There are no data on the fate of the preserved bicuspid aortic valve (BAV) in patients with acute type A aortic dissection. We investigated surgical outcomes in BAV patients who had undergone aortic valve resuspension versus replacement for dissection type A.
  
  
  METHODS
  Among 1,500 consecutive patients operated on for acute type A dissection between 1993 and 2013 at 3 tertiary centers, 66 had BAV (68% males, median age 60 ± 15 years). Thirteen BAV resuspension patients were compared with 53 BAV replacement patients. Median follow-up was 5.0 ± 4.7 years.
  
  
  RESULTS
  The ages of both groups were similar (resuspension 62 ± 13 vs replacement 57 ± 15 years, p = 0.62), and both presented similar risk-factor profiles. Moderate-to-severe aortic valve regurgitation was observed in 15% of the resuspension and 45% of the replacement patients (p = 0.06). Resuspension patients required shorter cardiopulmonary bypass and cross-clamp times (153 ± 48 vs 224 ± 76 min, p < 0.01; 106 ± 33 vs 172 ± 57 min, p < 0.01, respectively). In-hospital mortality was observed in 15.4% of the resuspension and 15.1% of the replacement patients (p = 1). One replacement patient underwent a proximal reoperation. The resuspension group experienced no severe aortic regurgitation, nor any need for proximal reintervention. Overall survival was 68% ± 13% vs 65% ± 7% at 5 years in resuspension and replacement groups, respectively (log- rank, p = 0.97).
  
  
  CONCLUSIONS
  The BAV resuspension in type A dissection patients showed good short- and mid-term results. It is doable with acceptable results, and full root replacement is not always necessary.
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: bartosz.rylski@universitaets-herzzentrum.de.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rylski
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors.forename: Fabian A
authors.initials: FA
authors.lastname: Kari
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors.forename: Linda
authors.initials: L
authors.lastname: Grün
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rita K
authors.initials: RK
authors.lastname: Milewski
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Saitama, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Saitama, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications* / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies