Evaldas Girdauskas1, Kushtrim Disha2, Mina Rouman2, Andres Espinoza2, Michael A Borger3, Thomas Kuntze2. 1. Department of Cardiac Surgery, Heart Center, Central Hospital Bad Berka, Bad Berka, Germany egirdauskas@web.de evagird@centras.lt. 2. Department of Cardiac Surgery, Heart Center, Central Hospital Bad Berka, Bad Berka, Germany. 3. Cardiovascular Institute, Columbia University Medical Center, New York, USA.
Abstract
OBJECTIVES: Various forms of bicuspid aortic valve (BAV) aortopathy exist, and the optimal treatment for the different subgroups is insufficiently defined. We aimed to analyse the risk of adverse aortic events after aortic valve replacement (AVR) for BAV insufficiency and concomitant mild-to-moderate dilatation of the aortic root (i.e. BAV root phenotype). METHODS: A total of 56 consecutive patients (mean age 47 ± 11 years, 95% men) with BAV insufficiency and a root diameter of 40-50 mm underwent AVR surgery from 1995 to 2008. All patients, as identified from our institutional BAV database, had a dilated aortic annulus (i.e. defined as valve prosthesis size ≥27 mm) without aortic stenosis (i.e. mean gradient ≤20 mmHg). Patients who underwent concomitant aortic surgery were excluded. Follow-up (622 patient-years) including echocardiography data was available for all patients. Aortic events were defined as the need for proximal aortic surgery, the occurrence of aortic dissection/rupture, echocardiographic evidence of increasing aortic root diameter/occurrence of late paravalvular leakage or sudden death during follow-up. RESULTS: Actuarial survival was 90% at 10 years and 78% at 15 years. Adverse aortic events occurred in 19 (34%) study patients. Redo aortic surgery was performed in 6 patients (11%), 2 of which were for aortic dissection. Four patients (7%) suffered sudden cardiac death. Moreover, follow-up echocardiography revealed a significant, progressive enlargement of the aortic root diameter in 7 (13%) patients and occurrence of late de novo paravalvular leakage in 2 (3%) patients. The resultant freedom from aortic events was 81% at 10 years and 51% at 15 years. CONCLUSIONS: Patients with a BAV root phenotype are at significant risk of aortic events after isolated AVR. Simultaneous root/ascending aortic surgery should be strongly considered in such patients.
OBJECTIVES: Various forms of bicuspid aortic valve (BAV) aortopathy exist, and the optimal treatment for the different subgroups is insufficiently defined. We aimed to analyse the risk of adverse aortic events after aortic valve replacement (AVR) for BAV insufficiency and concomitant mild-to-moderate dilatation of the aortic root (i.e. BAV root phenotype). METHODS: A total of 56 consecutive patients (mean age 47 ± 11 years, 95% men) with BAV insufficiency and a root diameter of 40-50 mm underwent AVR surgery from 1995 to 2008. All patients, as identified from our institutional BAV database, had a dilated aortic annulus (i.e. defined as valve prosthesis size ≥27 mm) without aortic stenosis (i.e. mean gradient ≤20 mmHg). Patients who underwent concomitant aortic surgery were excluded. Follow-up (622 patient-years) including echocardiography data was available for all patients. Aortic events were defined as the need for proximal aortic surgery, the occurrence of aortic dissection/rupture, echocardiographic evidence of increasing aortic root diameter/occurrence of late paravalvular leakage or sudden death during follow-up. RESULTS: Actuarial survival was 90% at 10 years and 78% at 15 years. Adverse aortic events occurred in 19 (34%) study patients. Redo aortic surgery was performed in 6 patients (11%), 2 of which were for aortic dissection. Four patients (7%) suffered sudden cardiac death. Moreover, follow-up echocardiography revealed a significant, progressive enlargement of the aortic root diameter in 7 (13%) patients and occurrence of late de novo paravalvular leakage in 2 (3%) patients. The resultant freedom from aortic events was 81% at 10 years and 51% at 15 years. CONCLUSIONS:Patients with a BAV root phenotype are at significant risk of aortic events after isolated AVR. Simultaneous root/ascending aortic surgery should be strongly considered in such patients.
Authors: Hector I Michelena; Alessandro Della Corte; Arturo Evangelista; Joseph J Maleszewski; William D Edwards; Mary J Roman; Richard B Devereux; Borja Fernández; Federico M Asch; Alex J Barker; Lilia M Sierra-Galan; Laurent De Kerchove; Susan M Fernandes; Paul W M Fedak; Evaldas Girdauskas; Victoria Delgado; Suhny Abbara; Emmanuel Lansac; Siddharth K Prakash; Malenka M Bissell; Bogdan A Popescu; Michael D Hope; Marta Sitges; Vinod H Thourani; Phillippe Pibarot; Krishnaswamy Chandrasekaran; Patrizio Lancellotti; Michael A Borger; John K Forrest; John Webb; Dianna M Milewicz; Raj Makkaar; Martin B Leon; Stephen P Sanders; Michael Markl; Victor A Ferrari; William C Roberts; Jae-Kwan Song; Philipp Blanke; Charles S White; Samuel Siu; Lars G Svensson; Alan C Braverman; Joseph Bavaria; Thoralf M Sundt; Gebrine El Khoury; Ruggero De Paulis; Maurice Enriquez-Sarano; Jeroen J Bax; Catherine M Otto; Hans-Joachim Schäfers Journal: Radiol Cardiothorac Imaging Date: 2021-07-22