Original article
Adult cardiac
Type A Aortic Dissection in Patients With Bicuspid Aortic Valve Aortopathy

https://doi.org/10.1016/j.athoracsur.2019.05.022Get rights and content

Background

The aim of this study was to evaluate clinical, aortic, and outcome characteristics of type A aortic dissection patients with bicuspid aortic valves (BAVs) and tricuspid aortic valves (TAVs).

Methods

Patient characteristics and radiographic, operative, and outcome data were evaluated and compared between 1068 TAV patients and 72 BAV patients operated on for type A aortic dissection in 2 centers. Predissection aortic diameters were calculated as previously reported for TAV patients.

Results

BAV patients were significantly younger (P < .001) and had a lower incidence of cardiovascular risk factors. Although the clinical presentation was similar, the dissection affected the abdominal aorta significantly more often in TAV patients (P = .029). Aortic root replacements were performed significantly more often in BAV patients (P < .001). Postoperative outcome was similar between the 2 groups. BAV patients had a significantly larger maximum postdissection diameter (P < .001) and calculated predissection diameter (P < .001) compared with TAV patients. Predissection ascending aortic diameters were less than 5.5 cm in 96% of all TAV patients and less than 5.0 cm in 76% of all BAV patients.

Conclusions

Acute type A aortic dissection in BAV patients is not associated with worse clinical or long-term outcome but significantly influences the proximal aortic repair. After modeling predissection aortic diameters, less than 5% of all TAV patients and possibly less than 25% of all BAV patients would meet the elective threshold for preventative replacement of the ascending aorta.

Section snippets

Patients and Follow-up Protocol

Date were obtained from prospectively maintained aortic databases in 2 centers, 1 in the United States (Hospital of the University of Pennsylvania) and 1 in Germany (University Heart Center Freiburg). A total of 1140 patients without connective tissue diseases surgically treated for type A aortic dissections between 2002 and 2017 were included in the analysis. During this period 72 BAV patients (6%) and 1068 TAV patients (94%) underwent surgery. Surgical characteristics, clinical features,

Patient Characteristics

BAV patients were significantly younger when compared with TAV patients (P < .001) and were characterized by a lower occurrence of cardiovascular risk factors. Hypertension was significantly less prevalent in BAV patients (P < .001). Details of patient demographics and risk factors are summarized in Table 1.

Clinical Characteristics

Details on the clinical presentation and the extent of the aortic dissection are summarized in Table 2. The clinical presentation between BAV and TAV patients was similar.

Aortic Characteristics

More frequently in

Comment

The most essential findings of this study can be summarized as follows. First, type A aortic dissections occur in BAV patients at a younger age despite the lower incidence of cardiovascular risk factors. Second, although the clinical presentation was similar, the dissection affected the downstream aorta more often in TAV patients. Third, analysis of predissection diameters confirms that almost all TAV patients fail to meet the current criteria for elective ascending aortic replacement. Finally,

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