A Mid-term Follow-up Study Of Ascending Aortic Dilation After Aortic Valve Replacement

Background:Our aim was to compare the diameter of the aorta after isolated aortic valve replacement surgery in patients with a bicuspid or tricuspid aortic valve and an initially normal ascending aorta.Methods:A total of 613 consecutive patients with ascending aortic diameter of less than 45 mm who underwent isolated AVR from 2002 through 2008 were studied. Of these patients,211 patients were diagnosed with a bicuspid aortic valve (BAV group), whereas the remaining 402 patients had a tricuspid aortic valve (TAV group). Diameter of ascending aorta was evaluated by ultrasonic cardiogram pre-and post-operation. Adverse aortic events were defined as the occurrence of ascending aortic aneurysm/dissection need for proximal surgery or sudden death during follow-up.Results:In both the BAV and TAV groups, the ascending aorta significantly expanded in the follow-up, from the preoperative size of 34.4±5.2 mm to postoperative 37.1±6.4 mm (p<0.001) in BAV group and 33.3±4.9 mm to 35.4±5.9 mm (p<0.001) in TAV group; however, the amount of increase showed no significant difference between the two groups (p=0.119). Additionally, Cox regression showed no significant effect caused by BAV disease on the end-point events (64.0% in BAV group versus 45.7% in TAV group, log rank:p=0.50).Conclusions:Dilatation but still non-aneurysm of the ascending aorta was observed after AVR, and it did not show a more pronounced tendency in BAV patients. The dilatation in the two groups did not predict adverse aortic events; however, longer following-up for ascending aortic aneurysmal after AVR in both BAV and TAV patients is necessary.