Aortic complications after bicuspid aortic valve replacement: long-term results

Ann Thorac Surg. 2002 Nov;74(5):S1773-6; discussion S1792-9. doi: 10.1016/s0003-4975(02)04261-3.


Background: Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR).

Patients and methods: One hundred consecutive patients were allocated into two groups according to the presence of BAV (group A, 50 patients) or TAV (group B, 50 patients). Mean age was 51 +/- 12 years in group A, and 50 +/- years 12 in group B. No patients had hypertension or Marfan's syndrome. Until July 2001, mean follow-up was 234 +/- 47 months in group A and 241 +/- 43 months in group B.

Results: Five patients (10%, CL 5.7 to 13.9) in group A suffered late acute aortic dissection. Acute aortic dissection (5 vs 0, p = 0.0001) and sudden death (7 vs 0, p = 0.0001) occurred more frequently in patients with BAV. All survivors were assessed by echocardiogram. The mean diameter of the ascending aorta was 48.4 mm in group A and 36.8 mm in group B. Three patients in group A were operated on because of ascending aorta aneurysm more than 6 cm in diameter.

Conclusions: As a result of our experience, we recommend a policy of prophylactic replacement of even a seemingly normal and definitely a mildly enlarged ascending aorta in cases of BAV at the moment of AVR, and consideration of a similar approach for any other cardiac surgical procedure in patients with BAV.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aneurysm, Dissecting / etiology*
  • Aneurysm, Dissecting / mortality
  • Aneurysm, Dissecting / surgery
  • Aortic Aneurysm, Thoracic / etiology*
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery
  • Aortic Valve / abnormalities*
  • Aortic Valve / surgery
  • Death, Sudden, Cardiac / etiology
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / etiology*
  • Postoperative Complications / mortality
  • Postoperative Complications / surgery
  • Reoperation
  • Risk Assessment
  • Risk Factors
  • Survival Rate