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.
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U2 - 10.1016/j.jtcvs.2010.08.086
DO - 10.1016/j.jtcvs.2010.08.086
M3 - Article
C2 - 21071042
AN - SCOPUS:80051784353
SN - 0022-5223
VL - 142
SP - 602
EP - 607
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -