Yongshi Wang1, Boting Wu2, Jun Li3, Lili Dong4, Chunsheng Wang3, Xianhong Shu1. 1. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China. 2. Department of Transfusion, Zhongshan Hospital Fudan University, Shanghai, China. 3. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China. 4. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China. Electronic address: dong.lili@zs-hospital.sh.cn.
Abstract
BACKGROUND: Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. METHODS: From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. RESULTS: With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p < 0.001). The BAV-AI group showed a higher risk for adverse aortic events compared with both the BAV plus aortic stenosis (15.5% versus 4.5%; p = 0.008) and tricuspid aortic valve with aortic insufficiency (15.5% versus 6.0%; p = 0.018) groups. Cox regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. CONCLUSIONS: An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy.
BACKGROUND: Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. METHODS: From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. RESULTS: With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p < 0.001). The BAV-AI group showed a higher risk for adverse aortic events compared with both the BAV plus aortic stenosis (15.5% versus 4.5%; p = 0.008) and tricuspid aortic valve with aortic insufficiency (15.5% versus 6.0%; p = 0.018) groups. Cox regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. CONCLUSIONS: An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy.
Authors: Michael A Borger; Paul W M Fedak; Elizabeth H Stephens; Thomas G Gleason; Evaldas Girdauskas; John S Ikonomidis; Ali Khoynezhad; Samuel C Siu; Subodh Verma; Michael D Hope; Duke E Cameron; Donald F Hammer; Joseph S Coselli; Marc R Moon; Thoralf M Sundt; Alex J Barker; Michael Markl; Alessandro Della Corte; Hector I Michelena; John A Elefteriades Journal: J Thorac Cardiovasc Surg Date: 2018-08 Impact factor: 5.209
Authors: Malenka M Bissell; Margaret Loudon; Aaron T Hess; Victoria Stoll; Elizabeth Orchard; Stefan Neubauer; Saul G Myerson Journal: J Cardiovasc Magn Reson Date: 2018-02-08 Impact factor: 5.364