Original article
Cardiovascular
Risk Factors Associated With Reoperation and Mortality in 252 Patients After Aortic Valve Replacement for Congenitally Bicuspid Aortic Valve Disease

https://doi.org/10.1016/j.athoracsur.2006.10.047Get rights and content

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.

Section snippets

Patients

From February 1971 through March 2002, all patients who underwent AVR surgery for congenital BAV were identified through our division’s computerized database for inclusion in the study if they did not undergo concomitant AA repair or replacement or other valve replacement surgery. This study was approved by the Institutional Review Board at Cedars-Sinai Medical Center with a waiver to obtain consent based on the retrospective study nature and removal of identification of patient data. All

Results

A total of 252 patients with BAV underwent AVR without concomitant replacement of AA. The mean follow-up was 8.9 ± 6.3 years (range, 0–31.0 years). Of the 252 patients, 50.4% had aortic stenosis, 12.4% had aortic regurgitation, and 37.2% mixed lesions.

All patients underwent AVR; no aortic valve repair was done. A tissue valve was used in 35.3% of patients, a mechanical valve in 54.4% of patients, and a pulmonary allograft was placed in 10.3% of patients. Concomitant coronary artery bypass graft

Comment

Bicuspid aortic valve disease is a common congenital cardiac disorder affecting 1% to 2% of the general population with an autosomal dominant inheritance pattern [1, 2, 24]. Large autopsy studies described aortic stenosis as the predominant lesion in a population with BAV with a lower incidence (10% to 15%) of aortic insufficiency and mixed lesions [4]. In the present study of 252 patients with BAV, we found that half of the patients had pure aortic stenosis and 37% had mixed lesions. The age

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