The significance of bicuspid aortic valve after surgery for acute type A aortic dissection

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 159; no. 3; pp. 760 - 767.e3
• Main Authors: Mennander, Ari, Olsson, Christian, Jeppsson, Anders, Geirsson, Arnar, Hjortdal, Vibeke, Hansson, Emma C., Jarvela, Kati, Nozohoor, Shahab, Gunn, Jarmo, Ahlsson, Anders, Gudbjartsson, Tomas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2020
• Subjects: acute aortic valve regurgitation; Acute Disease; acute type A aortic dissection; Adult; Aged; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm - complications; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Aortic Valve - abnormalities; Aortic Valve - diagnostic imaging; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - mortality; bicuspid aortic valve; Bicuspid Aortic Valve Disease; Cardiac and Cardiovascular Systems; Clinical Medicine; Databases, Factual; Female; Heart Valve Diseases - complications; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Humans; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Postoperative Cognitive Complications - etiology; Retrospective Studies; Risk Assessment; Risk Factors; Scandinavian and Nordic Countries; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Scandinavian and Nordic Countries; AR; acute aortic valve regurgitation; bicuspid aortic valve; BAV; TAV; ATAAD; acute type A aortic dissection
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2019.03.012

Decision-making concerning the extent of the repair of acute type A aortic dissection (ATAAD) includes functional and anatomical assessment of the aortic valve. We hypothesized that bicuspid aortic valve (BAV) does not impact outcome after surgery for ATAAD. We therefore evaluated the outcome after ATAAD surgery in relation to the presence of BAV, acute aortic regurgitation (AR), and surgical approach, using the Nordic Consortium for Acute Type A Aortic Dissection database.
Eight participating Nordic centers collected data from 1122 patients undergoing ATAAD surgery during the years 2005 to 2014. Early complications, reoperations and survival were compared between patients with BAV and tricuspid aortic valves (TAV) before and after propensity score matching for sex, age, AR, organ malperfusion, hemodynamic instability, and site of the tear. Mean follow-up (range) for patients with TAV and BAV was 3.1 years (0-10.4 years) and 3.2 years (0-9.0 years), respectively.
Altogether, 65 (5.8%) of the patients had BAV. Root replacement was more frequently performed in the BAV as compared with the TAV group (60% vs 23%, P < .001). Survival, however, did not differ significantly between patients with BAV or TAV, either before (P = .230) or after propensity score-matching (P = .812). Even so, in cohort as a whole, patients presenting with AR had less favorable survival.
Early and mid-term survival did not differ significantly between patients with BAV and TAV.
Propensity score−matched analysis was performed on 1122 patients undergoing surgery for acute type A aortic dissection. Mid-term survival did not differ significantly between 65 bicuspid aortic valve (BAV, blue line) and 260 tricuspid aortic valve (TAV, red line) patients. [Display omitted]