208Dilatation of the remaining aorta following aortic valve or root replacement in patients with bicuspid aortic valve


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Abstract

Purpose: The natural history and management of dilatation of the aorta in patients with bicuspid aortic valve (BAV) following aortic valve replacement (AVR) or aortic root replacement (ARR) remains controversial. We aim to identify dilatation of the remaining aorta following AVR or ARR in patients with BAV compared to patients with tricuspid aortic valve (TAV).Methods: 395 patients undergoing AVR or ARR between 2002 and 2009 were studied. Preoperative echocardiograms were performed on 192 BAV patients; these were compared with 203 TAV patients. Standard aortic measurements were taken. Ascending aorta diameter ≥4.5cm was regarded aneurysmal. Postoperative echocardiograms were compared with subsequent echocardiograms at a median follow-up of 3.8 years (1.2-6.8 years).Results: Median ages of BAV and TAV patients were 58±14 and 65±16 years respectively. Preoperative diameter of ascending aorta in BAV group with non aneurysmal aorta (n=143) was significantly higher than TAV group with non aneurysmal aorta, 3.5cm (Range, 3–4) (n=129, p<0.001). In both BAV and TAV groups with non aneurysmal aorta who underwent AVR, there was no significant increase in diameter of the ascending aorta and arch at 5 years follow-up. In patients with aneurysmal aorta, BAV (n=49) and TAV (n=74) who underwent ARR, there was also no significant difference in growth of the remaining aorta at 3 and 5 years follow-up.Conclusions: No significant dilatation of the aorta was observed following AVR or ARR in patients with BAV compared with TAV at 5 years following surgery. This supports intervention with ascending aorta ≥4.5cm in BAV patients with concomitant valvar disease.

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