Document Detail


Risk factors associated with reoperation and mortality in 252 patients after aortic valve replacement for congenitally bicuspid aortic valve disease.
MedLine Citation:
PMID:  17307436     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We aimed to determine the risk factors associated with mortality in patients with congenitally bicuspid aortic valve disease and dilation (<5 cm) of the ascending aorta after aortic valve replacement. METHODS: We reviewed 252 patients with bicuspid aortic valve undergoing aortic valve replacement at our institution from 1971 through 2000. Patients undergoing concomitant replacement of the ascending aorta were excluded. RESULTS: The average patient age was 61 +/- 15 years; 66.3% were male, and 40.5% of patients had coronary artery disease. The ascending aorta was normal (<4.0 cm) in 60.3%, mildly dilated (4.0 to 4.4 cm) in 24.2%, and moderately dilated (4.5 to 4.9 cm) in 15.5% of patients. Patients with moderate aortic dilatation had significantly lower prevalence of coronary artery disease compared with patients with normal ascending aortas (20.5% and 45.4%; p = 0.006). Mean follow-up was 8.9 +/- 6.3 years. Long-term survival was significantly different across the three groups (p = 0.004). The 5-, 10-, and 15-year estimates were 78%, 59%, and 37%, respectively, in the normal aorta group; 88%, 77%, and 46%, respectively, in the mild aortic dilation group; and 92%, 83%, and 70%, respectively, in the moderate aortic dilation group. No significant difference in cardiac death was found among the groups (p = 0.08). The significant predictors of survival using the Cox regression model were coronary artery disease, age, decade of surgery, and ejection fraction. Aortic dilation was not significant after adjusting for these other variables. At follow-up, 18 patients required reoperation, 17 for aortic valve prosthesis failure and 1 for ascending aorta aneurysm. CONCLUSIONS: The present study highlights the important adverse effect of concomitant coronary artery disease, advanced age, earlier decade of surgery, and reduced left ventricular ejection fraction on survival after aortic valve replacement for bicuspid aortic valve in patients with no or mild and moderate (<5 cm) dilation of the ascending aorta.
Authors:
Sorel Goland; Lawrence S C Czer; Michele A De Robertis; James Mirocha; Robert M Kass; Gregory P Fontana; Wen Chang; Alfredo Trento
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-19     Completed Date:  2007-03-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  931-7     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aorta / physiopathology
Aortic Diseases / etiology*,  physiopathology,  surgery*
Aortic Valve / abnormalities*,  surgery
Cardiac Surgical Procedures / adverse effects*,  mortality*
Cohort Studies
Dilatation, Pathologic / etiology,  physiopathology,  surgery
Female
Follow-Up Studies
Heart Defects, Congenital / surgery*
Humans
Male
Middle Aged
Reoperation / mortality
Retrospective Studies
Risk Factors
Survival Analysis

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


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