Surgical Treatment of Dilated Ascending Aorta in Bicuspid Aortic Valve Patients: Repair or Replacement of the Ascending Aorta?_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QINWei , CHENXin ,  HUANGFu-hua

Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Hospital, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding author：

HUANGFu-hua, Email: huangfuhua@sina.cn

Keywords：

Bicuspid aortic valve; Dilated ascending aorta; Graft replacement; Repair

DOI：

10.7507/1007-4848.20150253

Video：

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Objective To compare the recent and mid-term results of two different treatments in bicuspid aortic valve (BAV) patients with dilated ascending aorta. Methods From march 2007 to April 2014, there were totally 70 BAV patients received surgical treatment in Nanjing Cardiovascular Disease Hospital. According to the procedure of the ascending aorta, they were divided into two groups. As for group A which repaired the ascending aorta, there were 28 males and 9 females with an average age of 58.68±8.01 years. As for group B which replaced the ascending aorta, there were 25 males and 8 females with an average age of 54.18±11.97 years. And we compared perioperative clinical data and follow-up results of these two groups. Results There were statistical differences between the two groups in cardiopulmonary bypass time, aortic cross clamping time, and ICU stay time (105.19±11.17 min vs. 180.94±32.10 min, P=0.000; 78.65±13.18 min vs. 110.24±29.64 min, P=0.000; 1.62±1.09 d vs. 3.58±2.89 d, P=0.001). And the time of the group A is shorter than that in the group B. Two patients in the group B died postoperatively, and the other 68 patients discharged. There was no significant difference in cumulative survival rate between the two groups (P=0.582). Postoperative following-up results showed that the ascending aortic diameter of both groups was smaller than that during the preoperative period. And at the latest time of the following-up, ascending aortic diameter was increased compared with pre-discharge in the group A (38.50±1.77 mm vs. 34.85±1.53 mm, P=0.007). But there was no increase in the group B. Conclusion We suggests simultaneous treatment to dilated ascending aorta for BAV patients. Both the repair and replacement procedure could achieve satisfactory recent and mid-term results.

Citation： QINWei, CHENXin, HUANGFu-hua. Surgical Treatment of Dilated Ascending Aorta in Bicuspid Aortic Valve Patients: Repair or Replacement of the Ascending Aorta?. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1016-1021. doi: 10.7507/1007-4848.20150253 Copy

1.	Mohamed SA,Hanke T,Schlueter C,et al.Ubiquitin fusion degradation 1-like gene dysregulation in bicuspid aortic valve.J Thorac Cardiovasc Surg,2005,130(6):1531-1536.
2.	Horne BD,Camp NJ,Muhlestein JB,et al.Evidence for a heritable component in death resulting from aortic and mitral valve diseases.Circulation,2004,110(19):3143-3148.
3.	Movahed MR,Hepner AD,Ahmadi-kashani M.Echocardiographic prevalence of bicuspid aortic valve in the population.Heart Lung Circ,2006,15(5):297-299.
4.	Siu SC,Silversides CK.Bicuspid aortic valve disease.J Am Coll Cardiol,2010,55(25):2789-2800.
5.	Cecconi M1,Nistri S,Quarti A,et al.Aortic dilatation in patients with bicuspid aortic valve.J Cardiovasc Med(Hagerstown),2006,7(1):11-20.
6.	Borger MA,Prest on M,Ivanov J,et al.Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?J Thorac Cardiovasc Surg,2004,128(5):677-683.
7.	Morgan-Hughes GJ,Roobottom CA,Owens PE,et al.Dilatation of the aorta in pure,severe,bicuspid aortic valve stenosis.Am Heart J,2004,147(4):736-740.
8.	Thanassoulis G,Yip JW,Filion K,et al.Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves.Nat Clin Pract Cardiovasc Med,2008,5(12):821-828.
9.	Hiratzka LF,Bakris GL,Beckman JA,et al.2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis andmanagement of patients with thoracic aortic disease:executive summary.A report of the American College of Cardiology Foundation/American Heart Association Task Force on PracticeGuidelines,American Association for Thoracic Surgery,American College of Radiology,American Stroke Association,Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,Society of Interventional Radiology,Society of Thoracic Surgeons and Society for Vascular Medicine.Circulation,2010,121(13):e266-e369.
10.	Bonow RO,Carabello BA,Chatterjee K,et al.2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease):endorsed by the Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons.Circulation,2008,118(15):e523-e661.
11.	Vahanian A,Baumgartner H,Bax J,et al.Guidelines on the management of valvular heart disease:the task force on the management of valvular heart disease of the european society of cardiology.Euro Heart J,2007,28(2):230-268.
12.	石开虎,宣海洋,张飞,等.二叶式主动脉瓣畸形合并升主动脉扩张的外科治疗.安徽医科大学学报,2011,46(2):1321-1323.
13.	Karamlou T,Shen I,Alsoufia B,et al.The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children:30-year results from a single institution.Eur J Cardiothorac Surg,2005,27(1):81-85.
14.	郑居兵,董然,刘韬帅,等.114例先天性主动脉瓣二瓣化畸形的外科治疗及中远期随访.心肺血管病杂志,2011,30(3):198-201.
15.	Niclauss L,Delay D,Ruchat P,et al.Reduction aortoplasty:safe and durable treatment for borderline dilatation in selected patients.J Heart Valve Dis,2012,21(5):584-590.
16.	Hwang HY,Shim MS,Park EA,et al.Reduction aortoplasty for the ascending aortic aneurysm with aortic valve disease:Does bicuspid valve matter?Circ J,2011,75(2):322-328.
17.	Ozcan AV,Alsalaldeh M,Boysan E,et al.Ascending aortic aneurysm treatment with linear plication and external wrapping technique:mid-term results.J Card Surg,2013,28(4):421-426.
18.	Della Corte A,De Feo M,Bancone C,et al.Long-term follow-up of reduction ascending aortoplasty with autologous partial wrapping:for which patient is waistcoat aortoplasty best suited?Interact Cardiovasc Thorac Surg,2012,14(1):56-63.
19.	Walker T,Bail DH,Gruler M,et al.Unsupported reduction ascending aortoplasty:fate of diameter and of windkessel function.Ann Thorac Surg,2007,83(3):1047-1054.
20.	Polvani G,Barili F,Dainese L,et al.Reduction ascending aortoplasty:midterm follow-up and predictors of re-dilatation.Ann T horac S urg,2006,82(2):586-591.
21.	Davies JE,Sundt TM.Surgery insight:the dilated ascending aortaindications for surgical intervention.Nat Clin Pract Cardiovasc Med,2007,4(6):330-339.
22.	Borger MA,Prest on M,Ivanov J,et al.Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?J T horac Cardi ovasc Surg,2004,128(5):677-683.
23.	Keane MG,Wiegers SE,Plappert T,et al.Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions.Circulation,2000,102(19 Suppl 3):Ⅲ35-Ⅲ39.
24.	Della Corte A,Bancone C,Quarto C,et al.Predictors of ascending aortic dilatation with bicuspid aortic valve:a wide spectrum of disease expression.Eur J Cardiothorac Surg,2007,31(3):397-404.
25.	Verma S,Yanagawa B,Kalra S,et al.Knowledge,attitudes,and practice patterns in surgical management of bicuspid aortopathy:a survey of 100 cardiac surgeons.J Thorac Cardiovasc Surg,2013,146(5):1033-1040.
26.	Nardi P,Pellegrino A,Russo M,et al.Mid-term results of different surgical techniques to replace dilated ascending aorta associated with bicuspid aortic valve disease.Ann Thorac Surg,2013,96(5):1648-1654.
27.	Conaglen P,Luthra S,Skillington P.Comparison of reduction ascending aortoplasty and ascending aortic replacement for bicuspid valve related aortopathy in young adult patients undergoing aortic valve replacement——long-term follow-up.Heart Lung Circ,2009,18(5):337-342.
28.	Akgullu C,Hekim T,Eryilmaz U,et al.Spontaneous retrograde dissection of the ascending aorta in a patient with a bicuspid aortic valve.Cardiovasc J Afr,2013,24(5):e8-e10.
29.	Eleid MF,Forde I,Edwards WD,et al.Type A aortic dissection in patients with bicuspid aortic valves:clinical and pathological comparison with tricuspid aortic valves.Heart,2013,99(22):1668-1674.
30.	Girdauskas E,Disha K,Raisin HH,et al.Risk of late aortic events after an isolated aortic valve replacement for bicuspid aortic valve stenosis with concomitant ascending aortic dilation.Eur J Cardiothorac Surg,2012,42(5):832-837.
31.	McKellar SH,Michelena HI,Li Z,et al.Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves.Am J Cardiol,2010,106(11):1626-1633.

1. Mohamed SA,Hanke T,Schlueter C,et al.Ubiquitin fusion degradation 1-like gene dysregulation in bicuspid aortic valve.J Thorac Cardiovasc Surg,2005,130(6):1531-1536.
2. Horne BD,Camp NJ,Muhlestein JB,et al.Evidence for a heritable component in death resulting from aortic and mitral valve diseases.Circulation,2004,110(19):3143-3148.
3. Movahed MR,Hepner AD,Ahmadi-kashani M.Echocardiographic prevalence of bicuspid aortic valve in the population.Heart Lung Circ,2006,15(5):297-299.
4. Siu SC,Silversides CK.Bicuspid aortic valve disease.J Am Coll Cardiol,2010,55(25):2789-2800.
5. Cecconi M1,Nistri S,Quarti A,et al.Aortic dilatation in patients with bicuspid aortic valve.J Cardiovasc Med(Hagerstown),2006,7(1):11-20.
6. Borger MA,Prest on M,Ivanov J,et al.Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?J Thorac Cardiovasc Surg,2004,128(5):677-683.
7. Morgan-Hughes GJ,Roobottom CA,Owens PE,et al.Dilatation of the aorta in pure,severe,bicuspid aortic valve stenosis.Am Heart J,2004,147(4):736-740.
8. Thanassoulis G,Yip JW,Filion K,et al.Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves.Nat Clin Pract Cardiovasc Med,2008,5(12):821-828.
9. Hiratzka LF,Bakris GL,Beckman JA,et al.2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis andmanagement of patients with thoracic aortic disease:executive summary.A report of the American College of Cardiology Foundation/American Heart Association Task Force on PracticeGuidelines,American Association for Thoracic Surgery,American College of Radiology,American Stroke Association,Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,Society of Interventional Radiology,Society of Thoracic Surgeons and Society for Vascular Medicine.Circulation,2010,121(13):e266-e369.
10. Bonow RO,Carabello BA,Chatterjee K,et al.2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease):endorsed by the Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons.Circulation,2008,118(15):e523-e661.
11. Vahanian A,Baumgartner H,Bax J,et al.Guidelines on the management of valvular heart disease:the task force on the management of valvular heart disease of the european society of cardiology.Euro Heart J,2007,28(2):230-268.
12. 石开虎,宣海洋,张飞,等.二叶式主动脉瓣畸形合并升主动脉扩张的外科治疗.安徽医科大学学报,2011,46(2):1321-1323.
13. Karamlou T,Shen I,Alsoufia B,et al.The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children:30-year results from a single institution.Eur J Cardiothorac Surg,2005,27(1):81-85.
14. 郑居兵,董然,刘韬帅,等.114例先天性主动脉瓣二瓣化畸形的外科治疗及中远期随访.心肺血管病杂志,2011,30(3):198-201.
15. Niclauss L,Delay D,Ruchat P,et al.Reduction aortoplasty:safe and durable treatment for borderline dilatation in selected patients.J Heart Valve Dis,2012,21(5):584-590.
16. Hwang HY,Shim MS,Park EA,et al.Reduction aortoplasty for the ascending aortic aneurysm with aortic valve disease:Does bicuspid valve matter?Circ J,2011,75(2):322-328.
17. Ozcan AV,Alsalaldeh M,Boysan E,et al.Ascending aortic aneurysm treatment with linear plication and external wrapping technique:mid-term results.J Card Surg,2013,28(4):421-426.
18. Della Corte A,De Feo M,Bancone C,et al.Long-term follow-up of reduction ascending aortoplasty with autologous partial wrapping:for which patient is waistcoat aortoplasty best suited?Interact Cardiovasc Thorac Surg,2012,14(1):56-63.
19. Walker T,Bail DH,Gruler M,et al.Unsupported reduction ascending aortoplasty:fate of diameter and of windkessel function.Ann Thorac Surg,2007,83(3):1047-1054.
20. Polvani G,Barili F,Dainese L,et al.Reduction ascending aortoplasty:midterm follow-up and predictors of re-dilatation.Ann T horac S urg,2006,82(2):586-591.
21. Davies JE,Sundt TM.Surgery insight:the dilated ascending aortaindications for surgical intervention.Nat Clin Pract Cardiovasc Med,2007,4(6):330-339.
22. Borger MA,Prest on M,Ivanov J,et al.Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?J T horac Cardi ovasc Surg,2004,128(5):677-683.
23. Keane MG,Wiegers SE,Plappert T,et al.Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions.Circulation,2000,102(19 Suppl 3):Ⅲ35-Ⅲ39.
24. Della Corte A,Bancone C,Quarto C,et al.Predictors of ascending aortic dilatation with bicuspid aortic valve:a wide spectrum of disease expression.Eur J Cardiothorac Surg,2007,31(3):397-404.
25. Verma S,Yanagawa B,Kalra S,et al.Knowledge,attitudes,and practice patterns in surgical management of bicuspid aortopathy:a survey of 100 cardiac surgeons.J Thorac Cardiovasc Surg,2013,146(5):1033-1040.
26. Nardi P,Pellegrino A,Russo M,et al.Mid-term results of different surgical techniques to replace dilated ascending aorta associated with bicuspid aortic valve disease.Ann Thorac Surg,2013,96(5):1648-1654.
27. Conaglen P,Luthra S,Skillington P.Comparison of reduction ascending aortoplasty and ascending aortic replacement for bicuspid valve related aortopathy in young adult patients undergoing aortic valve replacement——long-term follow-up.Heart Lung Circ,2009,18(5):337-342.
28. Akgullu C,Hekim T,Eryilmaz U,et al.Spontaneous retrograde dissection of the ascending aorta in a patient with a bicuspid aortic valve.Cardiovasc J Afr,2013,24(5):e8-e10.
29. Eleid MF,Forde I,Edwards WD,et al.Type A aortic dissection in patients with bicuspid aortic valves:clinical and pathological comparison with tricuspid aortic valves.Heart,2013,99(22):1668-1674.
30. Girdauskas E,Disha K,Raisin HH,et al.Risk of late aortic events after an isolated aortic valve replacement for bicuspid aortic valve stenosis with concomitant ascending aortic dilation.Eur J Cardiothorac Surg,2012,42(5):832-837.
31. McKellar SH,Michelena HI,Li Z,et al.Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves.Am J Cardiol,2010,106(11):1626-1633.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Dilated Ascending Aorta in Bicuspid Aortic Valve Patients: Repair or Replacement of the Ascending Aorta?

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