Fate of the normal-sized ascending aorta after aortic valve replacement
in bicuspid aortic valve disease
Abstract
Background and Aims: Bicuspid aortic valve (BAV) related aortopathy has
been a controversial issue in the past few years. Most of the researches
focused on BAV with dilated ascending aorta after aortic valve
replacement (AVR), but there were limited documents of patients with the
normal-sized proximal aorta. We retrospectively analyzed the clinical
data of patients undergoing AVR in our institution and evaluated the
progression of the unreplaced ascending aorta in a relatively long term
follow-up. Methods: In our institution, 165 patients were consecutively
recruited from July 2004 to December 2017. Detailed perioperative
information and follow-up data were comprehensively collected and
quantitatively analyzed. Results: 48 patients (29.1%) had BAV, while
TAV was found in 117 patients. A significant difference was observed in
diameters of ascending aorta at baseline between BAV and TAV group (37.5
±4.2mm vs 35.1 ±4.4mm; p=0.001). The overall survival rates were 89%
and 95.8% at 10 years postoperatively in BAV versus TAV group (Plog
rank=0.138). Only 1 patient suffered an aortic dissection and underwent
proximal aortic surgery. No difference in the progression of ascending
aorta (0.8±4.7mm vs 0.6±3.5mm, p=0.821) was observed. The diameter of
ascending aorta at baseline was a significant predictor of progression
in ascending aorta. Conclusions: BAV patients with a normal-sized
ascending aorta have a considerable low incidence of late adverse aortic
events after AVR. Meanwhile, the progression of the unreplaced ascending
aorta in BAV patients is not different from that in TAV patients.