Surgical Treatment of Bicuspid Aortic Valve Combined with Toracic Aortic Dilation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIYang ,  WUZhong , ZHUDa , BAIZhi-xuan , ZHANGEr-yong

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WUZhong, Email: wuzhong71@163.com

Keywords：

Bicuspid aortic valve; Thoracic aortic dilation; Surgical treatment

DOI：

10.7507/1007-4848.20150284

Video：

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Objective To analyze the clinical characteristics and surgical treatment of bicuspid aortic valve combined with thoracic aortic dilation. Methods We retrospectively analyzed the clinical data of 68 patients of bicuspid aortic valve combined with thoracic aortic dilation underwent surgical treatment in our hospital between January 2010 and June 2014. There were 47 males and 21 females at age of 26-77(44.5±16.3) years. Different surgical treatments including Wheat procedure(n=22), aortic valve replacement+ascending aortoplasty(n=10), Bentall procedure(n=13), aortic valve replacement+ascending aortic replacement+right hemi aortic arch replacement(n=13), Bentall procedure+ascending aortic replacement+right hemi aortic arch replacement(n=8), Bentall procedure+ascending aortic replacement+total arch replacement+stented elephant trunk(n=2) were carried out according to the type. Results All 68 patients underwent surgical treatment. The mortality in hospital is at 4.4%(3/68). The postoperative complications were neurological and mental complications(n=3), pneumonia(n=2), and exploratory thoracotomy(n=2). We followed up 63 patients for 6 months to 4 years. A total of 62 patients were well without reoperation except one death at the end of following-up 2 years. Conclusion Bicuspid aortic valve combined with thoracic aortic dilation has diversiform clinical characteristics. The surgical treatment should be chosen according to the aortic valve and thoracic aortic lesion characteristics.

Citation： LIYang, WUZhong, ZHUDa, BAIZhi-xuan, ZHANGEr-yong. Surgical Treatment of Bicuspid Aortic Valve Combined with Toracic Aortic Dilation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(12): 1143-1146. doi: 10.7507/1007-4848.20150284 Copy

1.	Ratib O, Perloff JK, Child JS. Images in cardiovascular medicine. Bicuspid aortic valve aneurysm. Circulation, 2004, 109(5):671.
2.	Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics-2008 update:a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2008, 117(4):e25-e146.
3.	Nistri S, Basso C, Marzari C, et al. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiol, 2005, 96(5):718-721.
4.	Tutar E, Ekici F, Atalay S, et al. The prevalence of bicuspid aortic valve in newborns by echocardiographic screening. Am Heart J, 2005, 150(3):513-515.
5.	Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol, 2004, 93(5):661-663.
6.	Bauer M, Pasic M, Meyer R, et al. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve. Ann Thorac Surg, 2002,74(1):58-62.
7.	Bonderman D, Gharehbaghi-Schnell E, Wollenek G, et al. Mechanisms underlying aortic dilatation in congenital aortic valve malformation. Circulation, 1999, 99(16):2138 -2143.
8.	Robicsek F, Thubrikar MJ, Cook JW, et al. The congenitally bicuspid aortic valve:how does it function? Why does it fail? Ann Thorac Surg, 2004, 77(1):177-185.
9.	Fazel SSI, Mallidi HR, Lee RS, et al. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J Thorac Cardiavasc Surg, 2008, 135(4):901-907.
10.	Tadros TM, Klein MD, Shapria OM. Ascending aortic dilatation associated with bicuspid aortic valve:pathophysiology, molecular biology, and clinical implications. Circulation, 2009, 119(6):880-890.
11.	Elefteriades JA. Natural history of thoracic aortic aneurysms:indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg, 2002, 74(5):S1877-1880; discussion S1892-1898.
12.	Borger MA, Preston 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.
13.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline 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. J Thorac Cardiovasc Surg, 2014, 148(1):e1-e132.
14.	David TE, Feindel CM. An aortic valve-sparing opeation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg, 1992, 103(4):617-621.
15.	Sarsam MA, Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg, 1993, 105(3):435-438.
16.	Kari FA, Liang DH, Kvitting JP, et al. Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl):S35-S40.
17.	Rahnavardi M, Yan TD, Bannon PG, et al. Aortic valve-sparing operations in aortic root aneurysms:remodeling or reimplantation? Interact Cardiovasc Thorac Surg, 2011, 13(2):189-197.
18.	Badiu CC, Eichinger W, Bleiziffer S, et al. Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation? Eur J Cardiothorac Surg, 2010, 38(5):515-522.
19.	许建屏, 郭宏伟, 史艺, 等. 主动脉成形术治疗主动脉瓣病变伴升主动脉扩张的疗效分析. 中华外科杂志, 2005, 43(10):638-640.
20.	张岩, 赵伟, 潘世伟, 等. 升主动脉成形术的早中期临床结果分析. 中国胸心血管外科临床杂志, 2014, 21(4):457-460.
21.	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.
22.	Park CB, Greason KL, Suri RM, et al. Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm? J Thorac Cardiovasc Surg, 2011, 142(3):602-607.

1. Ratib O, Perloff JK, Child JS. Images in cardiovascular medicine. Bicuspid aortic valve aneurysm. Circulation, 2004, 109(5):671.
2. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics-2008 update:a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2008, 117(4):e25-e146.
3. Nistri S, Basso C, Marzari C, et al. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiol, 2005, 96(5):718-721.
4. Tutar E, Ekici F, Atalay S, et al. The prevalence of bicuspid aortic valve in newborns by echocardiographic screening. Am Heart J, 2005, 150(3):513-515.
5. Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol, 2004, 93(5):661-663.
6. Bauer M, Pasic M, Meyer R, et al. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve. Ann Thorac Surg, 2002,74(1):58-62.
7. Bonderman D, Gharehbaghi-Schnell E, Wollenek G, et al. Mechanisms underlying aortic dilatation in congenital aortic valve malformation. Circulation, 1999, 99(16):2138 -2143.
8. Robicsek F, Thubrikar MJ, Cook JW, et al. The congenitally bicuspid aortic valve:how does it function? Why does it fail? Ann Thorac Surg, 2004, 77(1):177-185.
9. Fazel SSI, Mallidi HR, Lee RS, et al. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J Thorac Cardiavasc Surg, 2008, 135(4):901-907.
10. Tadros TM, Klein MD, Shapria OM. Ascending aortic dilatation associated with bicuspid aortic valve:pathophysiology, molecular biology, and clinical implications. Circulation, 2009, 119(6):880-890.
11. Elefteriades JA. Natural history of thoracic aortic aneurysms:indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg, 2002, 74(5):S1877-1880; discussion S1892-1898.
12. Borger MA, Preston 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.
13. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline 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. J Thorac Cardiovasc Surg, 2014, 148(1):e1-e132.
14. David TE, Feindel CM. An aortic valve-sparing opeation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg, 1992, 103(4):617-621.
15. Sarsam MA, Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg, 1993, 105(3):435-438.
16. Kari FA, Liang DH, Kvitting JP, et al. Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl):S35-S40.
17. Rahnavardi M, Yan TD, Bannon PG, et al. Aortic valve-sparing operations in aortic root aneurysms:remodeling or reimplantation? Interact Cardiovasc Thorac Surg, 2011, 13(2):189-197.
18. Badiu CC, Eichinger W, Bleiziffer S, et al. Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation? Eur J Cardiothorac Surg, 2010, 38(5):515-522.
19. 许建屏, 郭宏伟, 史艺, 等. 主动脉成形术治疗主动脉瓣病变伴升主动脉扩张的疗效分析. 中华外科杂志, 2005, 43(10):638-640.
20. 张岩, 赵伟, 潘世伟, 等. 升主动脉成形术的早中期临床结果分析. 中国胸心血管外科临床杂志, 2014, 21(4):457-460.
21. 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.
22. Park CB, Greason KL, Suri RM, et al. Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm? J Thorac Cardiovasc Surg, 2011, 142(3):602-607.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Bicuspid Aortic Valve Combined with Toracic Aortic Dilation

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