Introduction
Bicuspid aortic valve (BAV) is a very common congenital valvular
malformation, with a prevalence of 0.9~2% in general
population.1-3 Aortic valve degeneration is the main
problem for these patients, approximately half of them requiring aortic
valve replacement (AVR) because of valvular stenosis, regurgitation or
infective endocarditis. Even in the absence of aortic valve dysfunction,
they may be associated with a high risk of ascending aortic dilatation,
which leads to aortic aneurysm and
dissection.4
The
ascending aorta of BAV may still dilate progressively after AVR, which
leads to an increased risk of adverse aortic complication (ie., aortic
dissection and rupture).5 As a result , the recent
American College of Cardiology/ American Heart Association guidelines
indicated replacement of the moderately enlarged ascending
aorta(>45mm) in case of concomitant surgery of valvular
heart disease.6 Some centers have even adopted a more
aggressive surgical strategy, relaxing the indication for proximal
aortic surgery to 40mm in diameter. Moreover, Russo and colleagues
proposed a “prophylactic” replacement of the ascending aorta in young
BAV patients regardless of its size.7 This phenomenon
was based on the hypothesis of genetic aortopathy in BAV. However, there
were also some researchers questioning such an aggressive surgical
approach.8, 9
The majority of researches focused on the dilated ascending aorta, there
are few data on the progression of normal-sized ascending aorta after
AVR in BAV population with respect to those with tricuspid aortic valve
(TAV). Therefore, we retrospectively analyzed the clinical data of
patients undergoing AVR in our institution, and evaluated the
progression of unreplaced ascending aorta in a relatively long term
follow-up.