Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm?

Chan B. Park, Kevin L. Greason, Rakesh M. Suri, Hector I Michelena, Hartzell V Schaff, Thoralf M. Sundt

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objectives: Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting. Methods: We identified patients with bicuspid aortic valve undergoing repair or replacement of the ascending aorta with or without aortic valve replacement or root replacement between January1988 and December 2007 at our institution. Follow-up was by review of clinical records and postal questionnaire. Results: Of 470 patients identified, 48 patients had hemiarch or total arch replacement and were excluded. Of the remaining 422 patients, 227 had separate aortic valve replacement or repair and ascending aortoplasty (76) or ascending aortic graft replacement (175), 107 a valved conduit, 40 a homograft root, and 21 a valve-sparing root replacement. The mean age was 56 ± 15 years, and 80% were male. Follow-up was up to 17 (median 4.2) years. There were 23 (5.5%) late reoperations, of which none were for arch dilatation. Survival at 1, 5, 10, and 12 years was 96.5%, 89.6%, 77.7%, and 74.0%. Freedom from late reoperation was 98.7%, 94.1%, 81.0%, and 81.0%. Paired echocardiographic measurements of aortic arch diameter (n = 58) were 33.3 mm preoperatively versus 31.9 mm postoperatively (P = .135) at a mean 4 years. Conclusions: Progressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.

Original languageEnglish (US)
Pages (from-to)602-607
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number3
DOIs
StatePublished - Sep 2011

Fingerprint

Aortic Diseases
Aortic Aneurysm
Thoracic Aorta
Reoperation
Aortic Valve
Aorta
Dilatation
Natural History
Allografts
Bicuspid Aortic Valve
Transplants
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm? / Park, Chan B.; Greason, Kevin L.; Suri, Rakesh M.; Michelena, Hector I; Schaff, Hartzell V; Sundt, Thoralf M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 3, 09.2011, p. 602-607.

Research output: Contribution to journalArticle

@article{150abfa9878d4e83836f464d9e79d114,
title = "Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm?",
abstract = "Objectives: Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting. Methods: We identified patients with bicuspid aortic valve undergoing repair or replacement of the ascending aorta with or without aortic valve replacement or root replacement between January1988 and December 2007 at our institution. Follow-up was by review of clinical records and postal questionnaire. Results: Of 470 patients identified, 48 patients had hemiarch or total arch replacement and were excluded. Of the remaining 422 patients, 227 had separate aortic valve replacement or repair and ascending aortoplasty (76) or ascending aortic graft replacement (175), 107 a valved conduit, 40 a homograft root, and 21 a valve-sparing root replacement. The mean age was 56 ± 15 years, and 80{\%} were male. Follow-up was up to 17 (median 4.2) years. There were 23 (5.5{\%}) late reoperations, of which none were for arch dilatation. Survival at 1, 5, 10, and 12 years was 96.5{\%}, 89.6{\%}, 77.7{\%}, and 74.0{\%}. Freedom from late reoperation was 98.7{\%}, 94.1{\%}, 81.0{\%}, and 81.0{\%}. Paired echocardiographic measurements of aortic arch diameter (n = 58) were 33.3 mm preoperatively versus 31.9 mm postoperatively (P = .135) at a mean 4 years. Conclusions: Progressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.",
author = "Park, {Chan B.} and Greason, {Kevin L.} and Suri, {Rakesh M.} and Michelena, {Hector I} and Schaff, {Hartzell V} and Sundt, {Thoralf M.}",
year = "2011",
month = "9",
doi = "10.1016/j.jtcvs.2010.08.086",
language = "English (US)",
volume = "142",
pages = "602--607",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm?

AU - Park, Chan B.

AU - Greason, Kevin L.

AU - Suri, Rakesh M.

AU - Michelena, Hector I

AU - Schaff, Hartzell V

AU - Sundt, Thoralf M.

PY - 2011/9

Y1 - 2011/9

N2 - Objectives: Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting. Methods: We identified patients with bicuspid aortic valve undergoing repair or replacement of the ascending aorta with or without aortic valve replacement or root replacement between January1988 and December 2007 at our institution. Follow-up was by review of clinical records and postal questionnaire. Results: Of 470 patients identified, 48 patients had hemiarch or total arch replacement and were excluded. Of the remaining 422 patients, 227 had separate aortic valve replacement or repair and ascending aortoplasty (76) or ascending aortic graft replacement (175), 107 a valved conduit, 40 a homograft root, and 21 a valve-sparing root replacement. The mean age was 56 ± 15 years, and 80% were male. Follow-up was up to 17 (median 4.2) years. There were 23 (5.5%) late reoperations, of which none were for arch dilatation. Survival at 1, 5, 10, and 12 years was 96.5%, 89.6%, 77.7%, and 74.0%. Freedom from late reoperation was 98.7%, 94.1%, 81.0%, and 81.0%. Paired echocardiographic measurements of aortic arch diameter (n = 58) were 33.3 mm preoperatively versus 31.9 mm postoperatively (P = .135) at a mean 4 years. Conclusions: Progressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.

AB - Objectives: Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting. Methods: We identified patients with bicuspid aortic valve undergoing repair or replacement of the ascending aorta with or without aortic valve replacement or root replacement between January1988 and December 2007 at our institution. Follow-up was by review of clinical records and postal questionnaire. Results: Of 470 patients identified, 48 patients had hemiarch or total arch replacement and were excluded. Of the remaining 422 patients, 227 had separate aortic valve replacement or repair and ascending aortoplasty (76) or ascending aortic graft replacement (175), 107 a valved conduit, 40 a homograft root, and 21 a valve-sparing root replacement. The mean age was 56 ± 15 years, and 80% were male. Follow-up was up to 17 (median 4.2) years. There were 23 (5.5%) late reoperations, of which none were for arch dilatation. Survival at 1, 5, 10, and 12 years was 96.5%, 89.6%, 77.7%, and 74.0%. Freedom from late reoperation was 98.7%, 94.1%, 81.0%, and 81.0%. Paired echocardiographic measurements of aortic arch diameter (n = 58) were 33.3 mm preoperatively versus 31.9 mm postoperatively (P = .135) at a mean 4 years. Conclusions: Progressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.

UR - http://www.scopus.com/inward/record.url?scp=80051784353&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80051784353&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2010.08.086

DO - 10.1016/j.jtcvs.2010.08.086

M3 - Article

C2 - 21071042

AN - SCOPUS:80051784353

VL - 142

SP - 602

EP - 607

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -