The optimal diameter at which replacement of the ascending aorta should be per formed in patients with bicuspid aortic valve disease is not known. We reviewed all patients with bicuspid aortic valves undergoing aortic...
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The optimal diameter at which replacement of the ascending aorta should be per formed in patients with bicuspid aortic valve disease is not known. We reviewed all patients with bicuspid aortic valves undergoing aortic valve replacement at our institution from 1979 through 1993(n=201). Patients undergoing concomitant r eplacement of the ascending aorta were excluded. Follow-up was obtained on 98% of patients and was 10.3 3.8(mean SD) years. The average patient age was 56 15 y ears, and 76%were male. The ascending aorta was normal(4.0 cm) in 115(57%) pat ients, 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 wit h marked dilation(5.0 cm) underwent replacement of the ascending aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patie nts required reoperation, predominantly for aortic valve prosthesis failure. Twe nty-two patients had long-term complications related to the ascending aorta: 1 8 required an operative procedure to replace the ascending aorta(for aortic aneu rysm), 1 had aortic dissection, and 3 experienced sudden cardiac death. Fifteen -year freedom from ascending aortarelated 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). Patients undergoing operations for bicuspid aortic valve disease should be considered for concomitant replacement of the asc ending aorta if the diameter is 4.5 cm or greater.
To ascertain if the operative technique has any influence on outcome, the surgical results after aortic root replacement using either a composite valve graft(CVG) or a separate graft and valve(SVG) were analyzed. Eigh...
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To ascertain if the operative technique has any influence on outcome, the surgical results after aortic root replacement using either a composite valve graft(CVG) or a separate graft and valve(SVG) were analyzed. Eighty-four patients received a CVG, and 36 had SVG replacement. The operative mortality rate was 6%for patients receiving a CVG and 3%for SVG replacement (non significant). Follow-up extended to 21 years (mean 124±45 months). The type of the procedure(SVG versus CVG) was not a significant predictor of in-hospital mortality, length of hospital stay, subsequent root dilatation(SVG), anastomotic dehiscence and subsequent surgery. The early and long-term results after CVG or SVG were similar, which reflects proper patient selection.
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