Thorac Cardiovasc Surg 2012; 60 - PP78
DOI: 10.1055/s-0031-1297725

Acute type A aortic dissection: do patients with bicuspid aortic valves dissect at a younger age than their tricuspid peers?

CD Etz 1, 2, S Leontyev 1, K von Aspern 1, F Girrbach 1, O Akhavuz 1, PM Dohmen 1, M Misfeld 1, MA Borger 1, FW Mohr 1
  • 1Leipzig Heart Center, Dept. of Cardiac Surgery, Leipzig, Germany
  • 2Mount Sinai School of Medicine, Dept. of Cardiothoracic Surgery, New York, United States

Objectives: Patients (pts) with bicuspid aortic valves (BAV) are at higher risk for aorta-related death (rupture or dissection) than their peers with a tricuspid valve (TAV). Yet it is unclear if BAVs present at a younger age and with a larger root/ascending aorta than their tricuspid peers when suffering acute type A aortic dissection.

Methods: 379 consecutive pts with acute type A aortic dissection, transferred to our institution for emergency surgery (11/1995–07/2011) after a median of 10(range:<1–336)hours after symptom onset, were included: 92% with TAV(N=348), 8% with BAV(N=31). Overall, 39% (N=149) of all pts presented with ectasia or root/ascending aneurysm.

Results: TAVs presented at a mean age of 62.4±13.3yrs of age, in contrast BAVs presented significantly younger – at a mean age of 48.6±13.8yrs (N=31, p≤ .005).

Fig.1

63% of all TAVs were male (N=218) vs. 71% of all BAVs (N=22). Aortic root/ascending ectasia/aneurysm was present in 52% of BAVs vs. 38% of TAVs. An entry tear was identified in 95%: in the root/asc aorta in 262 pts (69%), in the transverse arch in 97 pts (26%): in BAVs, the entry tear was located in the root/asc aorta in 83% (N=26) vs. 67% (N=236) in TAVs. Overall, 37% (N=139) underwent a composite root replacement: 77% of BAVs (N=24) vs. 33% of TAVs (N=115). 216 pts (57%) had a supracoronary ascending replacement: BAV:23%, N=7; TAV:60%, N=208). The remaining pts had aortic valve/root reconstruction; a total of 67 pts (18%) had an elephant trunk (BAV:10%; N=3 vs. TAV: 18%, N=64). Hospital mortality for all emergency cases was 19.8%(N=75): 22%(N=7) among BAV vs. 19.5%(N=68) among TAV pts. A stroke occurred in 16%(N=60): in 6%(N=2) of BAVs vs. 17%(N=58) of TAVs.

Conclusions: BAVs dissected at a younger age than their tricuspid peers. In more BAVs, acute type A aortic dissection occurred associated with aortic ectasia/aneurysm. The entry tear was located in the aortic root/ascending more often in BAV mandating complex root surgery.