Key result
In patients undergoing surgical aortic valve replacement for bicuspid aortic valve disease without aortic repair, no instances of aortic dissection or rupture occurred over a median follow-up of 59.1 months.
Why the study?
The surgical threshold for bicuspid aortic valve (BAV)-related aortopathy remains debated because of its uncertain etiology and prognosis.
Does leaving the ascending aorta unrepaired during SAVR for BAV disease result in adverse aortic events?
Cohort (n=720)
No
Does leaving the ascending aorta unrepaired during SAVR for BAV disease result in adverse aortic events?
In patients undergoing SAVR for BAV with an ascending aorta <55 mm, leaving the aorta unrepaired is associated with a very low risk of adverse aortic events and minimal aortic expansion.
May support conservative management in selected BAV patients with aorta <55 mm; leaves open need for randomized confirmation.
Background: The surgical threshold for bicuspid aortic valve (BAV)-related aortopathy is a matter of debate due to its uncertain etiology and prognosis.This study investigated the prognosis of unrepaired BAV aortopathy in patients undergoing surgical aortic valve replacement (SAVR). Methods:We retrospectively analyzed data from 720 patients (age, 60.8±11.5 years; 246 women) who underwent SAVR for BAV disease without aortic repair between 2005 and 2020 at Asan Medical Center.The clinical endpoints were defined as occurrences of sudden death, aortic dissection or rupture, and elective aortic repair.To estimate postoperative changes in the dimensions of the unrepaired aorta, the individual annual aortic expansion rate was calculated.Multiple linear regression models were used to evaluate the risk of aortic expansion.Results: The mean ascending aortic diameter was 39.5±4.6 mm, and 299 patients (41.5%) had a baseline ascending aorta diameter >40 mm.During 70.0±68.3months of follow-up, the mean annual aortic expansion rate was 0.39±1.96mm/yr, no aortic dissection or rupture was observed, and sudden deaths were reported in 12 patients (0.34% per person-year).Linear regression analysis revealed no significant correlation between the baseline ascending aortic diameter and postoperative aortic expansion (R 2 =0.004, β=-0.84,p=0.082).Conclusion: In selected patients undergoing SAVR for a BAV (<55 mm), the risk of adverse aortic events was very low.As this observation contradicts current practice guidelines advocating for proactive aortic replacement in dilated ascending aortas measuring >45 mm, the study results need further validation by studies involving larger populations or randomized controlled trials.
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Shin et al. (2023) conducted a cohort in Bicuspid aortic valve disease (n=720). Unrepaired ascending aorta after surgical aortic valve replacement was evaluated on Occurrences of sudden death, aortic dissection or rupture, and elective aortic repair. In patients undergoing surgical aortic valve replacement for bicuspid aortic valve disease without aortic repair, no instances of aortic dissection or rupture occurred over a median follow-up of 59.1 months.
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