Original articleAdult cardiacAortic Valve Morphology Determines the Presentation and Surgical Approach to Acute Type A Aortic Dissection
Section snippets
Study Population
Between 1993 and 2013, among 629 patients (age 61 years [range, 60 to 73 years], 64% men) operated on for acute Stanford type A aortic dissection, 41 patients (7%) had BAV. The diagnosis of BAV was confirmed at operation. Acute aortic dissection was defined as a dissection operated on no later than 14 days after the onset of symptoms. Ascending aortic diameter was assessed before operation by transesophageal echocardiography and was available in 482 patients (77%).
The institutional review
Clinical Presentation
Patients with BAV were an average of 6 years younger (55 [46; 67] vs 61 [51; 73] years; p = 0.030) (Fig 1) and were in a similar gender distribution (63% vs 64% males; p = 0.9) as TAV patients. The BAV patients had a lower incidence of hypertension (56% vs 81%; p < 0.001). The incidence of all other cardiovascular risk factors did not differ between the two groups (Table 1). Three BAV patients underwent aortic valve replacement 23, 8, and 4 years before type A dissection. Two BAV patients
Patients With BAV Experience Dissection at a Younger Age
Aortic dissection can occur at any age; however, the highest incidence of type A dissection is during the seventh and eighth decades [16]. The International Registry for Acute Aortic dissection investigators suggested that younger patients (<40 years old) who experienced type A or B aortic dissection more often had a BAV than did older patients (>40 years old; 9% vs 1%; p < 0.01) [17]. In a recent report from Shanghai on a relatively young type A dissection population including 30 BAV and 258
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