TY - JOUR
T1 - Natural History and Outcomes of Nonreplaced Aortic Sinuses in Patients With Bicuspid Aortic Valves
AU - Patlolla, Sri Harsha
AU - Schaff, Hartzell V.
AU - Bagameri, Gabor
AU - Dearani, Joseph A.
AU - Greason, Kevin L.
AU - Daly, Richard C.
AU - Crestanello, Juan A.
AU - Stulak, John M.
AU - King, Katherine S.
AU - Pochettino, Alberto
AU - Saran, Nishant
N1 - Publisher Copyright:
© 2022 The Society of Thoracic Surgeons
PY - 2022/2
Y1 - 2022/2
N2 - Background: Enlargement of the sinus of Valsalva (SOV) is common in patients with bicuspid aortic valves (BAVs), and management at the time of aortic valve replacement (AVR) and concomitant ascending aorta replacement/repair is controversial. Methods: Between January 2000 and July 2017, 400 patients with BAVs underwent AVR and concomitant ascending aorta repair (graft replacement, 79%; aortoplasty, 21%). To assess the impact of the initial SOV dimension on future dilatation and outcomes, patients were stratified into 2 groups: SOV of less than 40 mm (SOV<40 mm) (n = 209) and SOV of 40 mm or larger (SOV≥40 mm) (n = 191). Results: Patients with SOV≥40 mm were older and more often male. At a median follow-up of 8.1 years (interquartile range, 7.4-9.1 years), 6 patients underwent reoperations on the ascending or sinus portion of the aorta due to aneurysmal dilatation, and enlargement of the sinus was the primary indication for operation in 1 patient. Adjusted analysis showed that baseline SOV and SOV dimension over time were not associated with late outcomes. A gradual increase in SOV diameter over time was identified (P =.004). Patients with smaller baseline SOV diameters showed an initial early decrease in diameter, followed by gradual increase, whereas those with larger baseline diameters had a stable early phase, followed by gradual dilatation. Conclusions: Ascending aorta replacement may lead to an initial remodeling/stabilizing effect on the spared bicuspid aortic root, which is more pronounced in patients with lower SOV diameters. In addition, our data demonstrate that the retained aortic sinuses enlarge slowly, and within the limited follow-up of our study, SOV diameter was not a risk factor for survival or reoperation.
AB - Background: Enlargement of the sinus of Valsalva (SOV) is common in patients with bicuspid aortic valves (BAVs), and management at the time of aortic valve replacement (AVR) and concomitant ascending aorta replacement/repair is controversial. Methods: Between January 2000 and July 2017, 400 patients with BAVs underwent AVR and concomitant ascending aorta repair (graft replacement, 79%; aortoplasty, 21%). To assess the impact of the initial SOV dimension on future dilatation and outcomes, patients were stratified into 2 groups: SOV of less than 40 mm (SOV<40 mm) (n = 209) and SOV of 40 mm or larger (SOV≥40 mm) (n = 191). Results: Patients with SOV≥40 mm were older and more often male. At a median follow-up of 8.1 years (interquartile range, 7.4-9.1 years), 6 patients underwent reoperations on the ascending or sinus portion of the aorta due to aneurysmal dilatation, and enlargement of the sinus was the primary indication for operation in 1 patient. Adjusted analysis showed that baseline SOV and SOV dimension over time were not associated with late outcomes. A gradual increase in SOV diameter over time was identified (P =.004). Patients with smaller baseline SOV diameters showed an initial early decrease in diameter, followed by gradual increase, whereas those with larger baseline diameters had a stable early phase, followed by gradual dilatation. Conclusions: Ascending aorta replacement may lead to an initial remodeling/stabilizing effect on the spared bicuspid aortic root, which is more pronounced in patients with lower SOV diameters. In addition, our data demonstrate that the retained aortic sinuses enlarge slowly, and within the limited follow-up of our study, SOV diameter was not a risk factor for survival or reoperation.
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U2 - 10.1016/j.athoracsur.2021.03.037
DO - 10.1016/j.athoracsur.2021.03.037
M3 - Article
C2 - 33811890
AN - SCOPUS:85115927026
SN - 0003-4975
VL - 113
SP - 527
EP - 534
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -