Rajdeep Bilkhu1, Pouya Youssefi1, Gopal Soppa1, Panagiotis Theodoropoulos1, Simon Phillips2, Bernard Liban3, Anne Child4, Maite Tome4, Justin Nowell1, Rajan Sharma4, Mark Edsell3, Marjan Jahangiri5. 1. Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom. 2. Department of Clinical Perfusion, St. George's Hospital, London, United Kingdom. 3. Department of Anesthesia, St. George's Hospital, London, United Kingdom. 4. Department of Cardiology, St. George's Hospital, London, United Kingdom. 5. Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom. Electronic address: marjan.jahangiri@stgeorges.nhs.uk.
Abstract
BACKGROUND: Recent guidelines support more aggressive surgery for aneurysms of the ascending aorta and root in patients with bicuspid aortic valve. However, the fate of the arch after surgery of the root and ascending aorta is unknown. We set out to assess outcomes following root and ascending aortic surgery and subsequent growth of the arch. METHODS: Between 2005 and 2016, 536 consecutive patients underwent surgery for aneurysm of the root and ascending aorta; 168 had bicuspid aortic valve. Patients with dissection were excluded. Arch diameter was measured before and after surgery, at 6 months and then annually. RESULTS: Of 168 patients, 127 (75.6%) had aortic root replacement and 41 (24.4%) had ascending replacement. Mean age was 57 ± 12.8 years, 82.7% were men, and 5 operations were performed during pregnancy. There was 1 (0.6%) hospital death. One (0.6%) patient had a stroke and 1 (0.6%) had resternotomy for bleeding. Median intensive care unit and hospital stays were 1 and 6 days, respectively. Follow-up was complete for 94% at a median of 5.9 years (range, 1 to 139 months). Aortic arch diameter was 2.9 cm preoperatively and 3.0 cm at follow-up. There was 97% freedom from reoperation and none of the patients required surgery on the arch. CONCLUSIONS: Prophylactic arch replacement during aortic root and ascending aortic surgery in patients with bicuspid aortic valve is not supported. Our data do not support long-term surveillance of the rest of the aorta in this population.
BACKGROUND: Recent guidelines support more aggressive surgery for aneurysms of the ascending aorta and root in patients with bicuspid aortic valve. However, the fate of the arch after surgery of the root and ascending aorta is unknown. We set out to assess outcomes following root and ascending aortic surgery and subsequent growth of the arch. METHODS: Between 2005 and 2016, 536 consecutive patients underwent surgery for aneurysm of the root and ascending aorta; 168 had bicuspid aortic valve. Patients with dissection were excluded. Arch diameter was measured before and after surgery, at 6 months and then annually. RESULTS: Of 168 patients, 127 (75.6%) had aortic root replacement and 41 (24.4%) had ascending replacement. Mean age was 57 ± 12.8 years, 82.7% were men, and 5 operations were performed during pregnancy. There was 1 (0.6%) hospital death. One (0.6%) patient had a stroke and 1 (0.6%) had resternotomy for bleeding. Median intensive care unit and hospital stays were 1 and 6 days, respectively. Follow-up was complete for 94% at a median of 5.9 years (range, 1 to 139 months). Aortic arch diameter was 2.9 cm preoperatively and 3.0 cm at follow-up. There was 97% freedom from reoperation and none of the patients required surgery on the arch. CONCLUSIONS: Prophylactic arch replacement during aortic root and ascending aortic surgery in patients with bicuspid aortic valve is not supported. Our data do not support long-term surveillance of the rest of the aorta in this population.
Authors: Yunus Ahmed; Nitesh Nama; Ignas B Houben; Joost A van Herwaarden; Frans L Moll; David M Williams; C Alberto Figueroa; Himanshu J Patel; Nicholas S Burris Journal: Eur J Cardiothorac Surg Date: 2021-09-11 Impact factor: 4.191
Authors: Isao Anzai; Jacob Kriegel; Ilya Kim; Christian Pearsall; Matthew Lewis; Marlon Rosenbaum; Giovanni Ferrari; Isaac George; Hiroo Takayama Journal: JTCVS Open Date: 2021-02-16