Natural History of Ascending Aortic Aneurysms in the Setting of an Unreplaced Bicuspid Aortic Valve

• Published in: The Annals of thoracic surgery Vol. 83; no. 4; pp. 1338 - 1344
• Main Authors: Davies, Ryan R., MD, Kaple, Ryan K., BA, Mandapati, Divakar, MD, Gallo, Amy, MD, Botta, Donald M., MD, Elefteriades, John A., MD, Coady, Michael A., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2007; Elsevier Science
• Subjects: Adult; Age Distribution; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - epidemiology; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - epidemiology; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - physiopathology; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - mortality; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Confidence Intervals; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Humans; Incidence; Male; Medical sciences; Middle Aged; Mitral Valve; Odds Ratio; Probability; Proportional Hazards Models; Risk Assessment; Severity of Illness Index; Sex Distribution; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Survival Analysis; Ultrasonography, Doppler; 26; Treatment; Cardiac valvular disease; Respiratory disease; Pathogenesis; Surgery; Setting; Bicuspid aortic valve; Cardiovascular disease; Health service; Thorax; Congenital disease; Aortic aneurysm
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.10.074

Background Patients with bicuspid aortic valve (BAV) are at risk for valvular disease and ascending aortic aneurysms and dissections. Although others have investigated the need for concomitant repair, the natural history of aortic disease has not been addressed. Methods A review of our institutional clinical database identified 514 patients (326 male, 188 female) with unrepaired ascending aortic aneurysms followed from 1985 to 2005. Seventy patients (13.4%) diagnosed with BAV form group A; the remaining 445 patients form group B. Growth rates and risk factors for complications were assessed. Results Patients in group A had a lower incidence of hypertension ( p = 0.0185), carotid artery disease, and stroke ( p = 0.0184), and presented at an earlier age (49.0 versus 64.2 years, p < 0.0001). Group A also had a higher rate of aortic growth (0.19 versus 0.13 cm/year, p = 0.0102). The incidence of rupture and dissection were similar. Overall survival was better among patients with BAV ( p < 0.0001). Among patients with BAV, those with aortic stenosis had a higher risk of rupture, dissection, or death before operative repair than did those with normally functioning valves (odds ratio 10.475, 95% confidence interval: 1.153 to 95.155). Conclusions Aortic stenosis presents a significant added risk for patients with aneurysmal disease in the face of BAV. Despite faster rates of growth, however, patients with BAV have similar rates of aortic rupture, dissection, and death and improved long-term survival. Contributing to this finding may be the lower incidence of comorbidities, the younger age at presentation, and the more attentive follow-up with earlier operative repair.