Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?

J Thorac Cardiovasc Surg. 2004 Nov;128(5):677-83. doi: 10.1016/j.jtcvs.2004.07.009.


Objective: The optimal diameter at which replacement of the ascending aorta should be performed in patients with bicuspid aortic valve disease is not known.

Methods: We reviewed all patients with bicuspid aortic valves undergoing aortic valve replacement at our institution from 1979 through 1993 (n = 201). Patients undergoing concomitant replacement of the ascending aorta were excluded.

Results: Follow-up was obtained on 98% of patients and was 10.3 +/- 3.8 (mean +/- SD) years. The average patient age was 56 +/- 15 years, and 76% were male. The ascending aorta was normal (<4.0 cm) in 115 (57%) patients, mildly dilated (4.0-4.4 cm) in 64 (32%) patients, and moderately dilated (4.5-4.9 cm) in 22 (11%) patients. All patients with bicuspid aortic valves with marked dilation (>5.0 cm) underwent replacement of the ascending aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patients required reoperation, predominantly for aortic valve prosthesis failure. Twenty-two patients had long-term complications related to the ascending aorta: 18 required an operative procedure to replace the ascending aorta (for aortic aneurysm), 1 had aortic dissection, and 3 experienced sudden cardiac death. Fifteen-year freedom from ascending aorta-related complications was 86%, 81%, and 43% in patients with an aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4.5 to 4.9 cm, respectively ( P < .001).

Conclusions: Patients undergoing operations for bicuspid aortic valve disease should be considered for concomitant replacement of the ascending aorta if the diameter is 4.5 cm or greater.

MeSH terms

  • Aged
  • Aorta / surgery*
  • Aortic Aneurysm, Thoracic / complications
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Valve
  • Blood Vessel Prosthesis Implantation / methods*
  • Female
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / surgery*
  • Heart Valve Diseases / complications
  • Heart Valve Diseases / congenital
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome