title: Natural history of the ascending aorta after aortic valve replacement: risk factor analysis for late aortic complications after aortic valve replacement.
abstract: BACKGROUND
  The purpose of this study was to clarify the natural history of the ascending aorta and to identify risk factors for late ascending aortic events after first isolated aortic valve replacement (AVR).
  
  
  METHODS
  A total of 287 patients undergoing AVR were enrolled. The patients were categorized into two groups based on the diameter of the ascending aorta at the time of AVR, as determined by computed tomography: Group A (n = 233) was defined as an ascending aortic diameter <40 mm, and Group B (n = 54) was defined as an ascending aortic diameter ≥40 mm.
  
  
  RESULTS
  The mean follow-up period was 7.6 years. The baseline diameter of the ascending aorta was 31.4 ± 4.8 mm in Group A and 44.7 ± 4.2 mm in Group B. These values increased to 35.9 ± 7.4 mm in Group A and 50.1 ± 7.3 mm in Group B during the follow-up period (P < 0.001). Ten patients had acute type A aortic dissection (Group A: 1 patient vs. Group B: 9 patients; P < 0.001), and three patients had enlargement of the ascending aorta to ≥55 mm in diameter (Group A: 1 patient vs. Group B: 2 patients). Multivariate analysis revealed that the baseline ascending aortic diameter was the only significant risk factor for developing late ascending aortic events (P < 0.001).
  
  
  CONCLUSIONS
  AVR alone may not prevent further enlargement of the ascending aorta. An ascending aorta ≥40 mm in diameter at the time of AVR increased the risk of late ascending aortic events.
authors.affiliation: Division of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan. con318@ndmc.ac.jp.|Division of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan. con318@ndmc.ac.jp.|Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, 284-1 Yobecho, Ashikaga City, Tochigi, 326-0843, Japan. con318@ndmc.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Tsutsumi
authors.affiliation: Division of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hashizume
authors.affiliation: Division of Cardiovascular Surgery, Hiratsuka Municipal Hospital, Hiratsuka, Kanagawa, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Inoue
mesh_terms: D000784:Aortic Dissection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D001011:Aorta; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D001021:Aortic Valve / Q000601:surgery*; D005163:Factor Analysis, Statistical; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Aortic valve replacement; Ascending aortic diameter; Late aortic complication