Document Detail

Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves.
MedLine Citation:
PMID:  21094365     Owner:  NLM     Status:  MEDLINE    
Bicuspid aortic valve (BAV) is associated with ascending aortopathy predisposing to aneurysmal dilatation and dissection, even after successful aortic valve replacement (AVR). There is, however, scant evidence on which to make recommendations for prophylactic replacement of the ascending aorta at the time of AVR. The medical records of patients who underwent AVR for BAV without aortic replacement or repair from 1960 to 1995 were reviewed. Follow-up was by review of the medical record and postal questionnaire. Among 1,286 patients, the mean age at operation was 58 ± 14 years. During the follow-up interval (median 12 years, range 0 to 38), there were 13 documented aortic dissections (1%), 11 ascending aortic replacements (0.9%), and 127 documented cases of progressive aortic enlargement (9.9%). Fifteen-year freedom from aortic dissection, enlargement, or replacement was 89% (95% confidence interval [CI] 87% to 91%) and was lower in patients with documented aortic enlargement at the time of AVR (85%, 95% CI 81% to 89%) compared to those whose aortic dimensions were normal (93%, 95% CI 90% to 96%) (p = 0.001). Multivariate predictors of aortic complications included interval (subsequent) AVR (hazard ratio [HR] 3.5, 95% CI 2.3 to 5.4, p <0.001), concomitant coronary artery bypass grafting (HR 2.6, 95% CI 1.7 to 4.0, p <0.001), enlarged aorta (HR 1.8, 95% CI 1.3 to 2.6, p = 0.001), and history of tobacco abuse (HR 1.8, 95% CI 1.2 to 2.6, p = 0.003). Aortic dilatation did not predict mortality. In conclusion, despite a true risk for aortic events after AVR for BAV, the occurrence of aortic dissection was low. Any incremental surgical risk imposed by prophylactic replacement of the ascending aorta must be equally low.
Stephen H McKellar; Hector I Michelena; Zhuo Li; Hartzell V Schaff; Thoralf M Sundt
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-20     Revised Date:  2011-04-13    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1626-33     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Department of Surgery, Division of Cardiovascular Surgery, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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MeSH Terms
Aneurysm, Dissecting / diagnosis,  epidemiology*,  etiology
Aortic Aneurysm, Thoracic / diagnosis,  epidemiology*,  etiology
Aortic Rupture / diagnosis,  epidemiology*,  etiology
Aortic Valve / abnormalities*,  surgery
Follow-Up Studies
Heart Valve Diseases / complications,  diagnosis,  surgery*
Heart Valve Prosthesis*
Middle Aged
Minnesota / epidemiology
Retrospective Studies
Risk Factors
Time Factors
Comment In:
Am J Cardiol. 2011 Mar 15;107(6):958   [PMID:  21376934 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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