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- Title
184 BICUSPID AORTIC VALVE DISEASE AND ASCENDING AORTIC ANEURYSM: SHOULD THE AORTIC ROOT REPLACEMENT BE MANDATORY?
- Authors
Vendramin, I.; Meneguzzi, M.; Sponga, S.; Pompei, E.; Maiani, M.; Livi, U.
- Abstract
Objectives: Bicuspid aortic valve (BAV) is associated with higher risk of adverse aortic events, but the management of moderate aortic root dilatation is controversial.Methods: We reviewed 166 consecutive patients affected by BAV disease and ascending aorta aneurysm treated from 1994 through 2008 with the Bentall procedure (77 patients, Bentall group) and aortic valve replacement with supracoronary ascending aorta replacement (89 patients, SAAR group). Male sex ratio was similar in the 2 groups (91% vs 72%, P < 0.01); in the Bentall group patients were younger (55.7 ± 12 vs 60.5 ± 11 years, P = 0.03) and mean root diameter was larger (44 ± 6 mm vs 39 ± 5 mm, P < 0.01).Results: In the Bentall group, mean CPB time (201 ± 56 vs 173 ± 57 min, P < 0.01) and mean cross-clamp time (155 ± 42 min and 131 ± 38 min, P < 0.01) were longer. In-hospital mortality (97% vs 98%), 10-year (84 ± 4% vs 81 ± 6%) and 15-year (70.1 ± 8% vs 75.4 ± 8%) survival were similar (P = 0.61). There was a similar rate of sudden death (12% vs 6%, P = 0.38). In the SAAR group, after an immediate surgical reduction of aortic root diameter there was no progressive dilatation (preoperative 39 ± 5 mm, follow-up diameter 35.9 ± 4 mm, P < 0.01). Neither in a subgroup of SAAR patients with preoperative aortic root >40 mm was there a progression of the dilatation at mean follow-up of 97 ± 41 months (preoperative 42.8 ± 3 mm vs follow-up diameter 39.1 ± 4 mm P < 001).Conclusion: The shorter CPB and clamping time, the stability of the residual root at long-term follow-up and the low risk of adverse aortic events in the SAAR compared with Bentall groups leads us to consider the isolated aortic valve replacement associated with ascending aorta replacement as an alternative strategy, especially in high-risk and older patients.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2014, Vol 19, Issue suppl_1, pS55
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivu276.184