title: Are normal-sized ascending aortas at risk of late aortic events after aortic valve replacement for bicuspid aortic valve disease?
abstract: OBJECTIVE
  Bicuspid aortic valve (BAV)-associated aortopathy has been proposed to progress after isolated aortic valve replacement (AVR) surgery, which has been traditionally used as an argument against a TAVR procedure in this clinical subset. Still, more than half of BAV patients have a normal-sized proximal aorta at the time of AVR surgery. We aimed to analyse the long-term risk of adverse aortic events after isolated conventional AVR surgery for BAV and normal-sized proximal aorta.
  
  
  METHODS
  A total of 200 consecutive patients (mean age 56 ± 13 years, 73% men) with BAV disease and ascending aortic diameter of <40 mm underwent isolated conventional AVR from 1995 through 2008 and were identified from our institutional BAV database. Long-term follow-up data (a total of 1532 patient-years) were obtained for all hospital survivors. Composite adverse aortic/cardiovascular events were defined as the need for redo aortic surgery, the occurrence of aortic dissection/rupture, or sudden cardiac death during follow-up.
  
  
  RESULTS
  A total of 25 (13%) patients died after a mean follow-up of 8.5 ± 5 years post-AVR surgery, which resulted in an overall survival rate of 75 ± 6 and 87 ± 7% at 15 years postoperatively, for BAV-aortic stenosis and BAV-aortic regurgitation, respectively (P = 0.6). An adverse aortic event occurred in 1 (0.5%) study patient, while 5 (2.5%) further patients suffered sudden cardiac death. Only 1 patient required redo aortic surgery. No documented aortic dissection/rupture occurred. Redo AVR surgery due to endocarditis or structural valve degeneration was performed in 6 (3%) patients. The rate of freedom from composite adverse events was 92 ± 5 and 95 ± 4% at 15 years, for the AS and AR subgroups, respectively (P = 0.7).
  
  
  CONCLUSIONS
  BAV patients with aortic valve dysfunction and normal-sized ascending aorta are at considerably low risk of late adverse aortic events after isolated AVR.
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany k_disha@hotmail.com.
authors.forename: Kushtrim
authors.initials: K
authors.lastname: Disha
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Mina
authors.initials: M
authors.lastname: Rouman
authors.affiliation: Department of Cardiology, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Maria-Anna
authors.initials: MA
authors.lastname: Secknus
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Girdauskas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic event; Aortic valve replacement; Ascending aorta; Bicuspid aortic valve