title: Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve.
abstract: BACKGROUND
  Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial.
  
  
  METHODS
  From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR.
  
  
  RESULTS
  With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p < 0.001). The BAV-AI group showed a higher risk for adverse aortic events compared with both the BAV plus aortic stenosis (15.5% versus 4.5%; p = 0.008) and tricuspid aortic valve with aortic insufficiency (15.5% versus 6.0%; p = 0.018) groups. Cox regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group.
  
  
  CONCLUSIONS
  An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy.
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Yongshi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Transfusion, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Boting
authors.initials: B
authors.lastname: Wu
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China. Electronic address: dong.lili@zs-hospital.sh.cn.
authors.forename: Lili
authors.initials: L
authors.lastname: Dong
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Shu
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged