Does the 45 mm Size Cutoff for Ascending Aortic Replacement Predict Better Early Outcomes in Bicuspid Aortic Valve?

Yi-Jia Li; Wei-Guo Ma; Yue Qi; Jun-Ming Zhu; Ya Yang; Li-Zhong Sun

doi:10.1055/s-0040-1722197

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2022; 70(04): 289-296
DOI: 10.1055/s-0040-1722197

Original Cardiovascular

Does the 45 mm Size Cutoff for Ascending Aortic Replacement Predict Better Early Outcomes in Bicuspid Aortic Valve?

Authors

Yi-Jia Li

¹Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
Wei-Guo Ma

²Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
Yue Qi

³Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
Jun-Ming Zhu

²Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
Ya Yang

¹Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
Li-Zhong Sun

²Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China

Abstract

Alle Artikel dieser Rubrik

Abstract

Background The aim of this study is to test if the newly proposed 45 mm size criterion for ascending aortic replacement (AAR) in bicuspid aortic valve (BAV) patients undergoing aortic valve replacement (AVR) is predictive of improved early outcomes.

Methods Data of 306 BAV patients with an aortic diameter of ≥45 mm undergoing AVR alone or with AAR were retrospectively analyzed. Patients were divided into groups of AVR + AAR (n = 220) and AVR only (n = 86) based on if surgery was performed according to the 45 mm criterion. End point was early adverse events, including 30-day and in-hospital mortality, cardiac events, acute renal failure, stroke, and reoperation for bleeding. Cox regression was used to assess if conformance to 45 mm criterion could predict fewer early adverse events.

Results AVR + AAR group had significantly higher postoperative left ventricular ejection fraction (LVEF) (0.59 ± 0.09 vs. 0.55 ± 0.11, p = 0.006) and longer cardiopulmonary bypass (CPB) time (128 vs. 111 minutes, p = 0.002). Early adverse events occurred in 45 patients (14.7%), which was more prevalent in the AVR-only group (22.1% vs. 11.8%, p = 0.020). Conformance to the 45 mm criterion predicted lower rate of early adverse events (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.28–0.98, p = 0.042). After adjustment for gender, age, AAo diameter, sinuses of Valsalva diameter, preoperative LVEF, Sievers subtypes, BAV valvulopathy, and CPB and cross-clamp times, conformance to the 45 mm size criterion still predicted lower incidence of early adverse events (HR: 0.37, 95% CI: 0.15–0.90, p = 0.028).

Conclusions This study shows that conformance to 45 mm size cutoff for preemptive AAR during aortic valve replacement in patients with BAV was not associated with increased risk for adverse events and may improve early surgical outcomes.

Keywords

bicuspid aortic valve - ascending aorta - surgery - aortic valve replacement - surgical outcomes

Volltext

Referenzen

References
1 Etz CD, Homann TM, Silovitz D. et al. Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve. Ann Thorac Surg 2007; 84 (04) 1186-1193 , discussion 1193–1194
2 Nardi P, Pellegrino A, Russo M, Saitto G, Bertoldo F, Chiariello L. Midterm results of different surgical techniques to replace dilated ascending aorta associated with bicuspid aortic valve disease. Ann Thorac Surg 2013; 96 (05) 1648-1654
3 McKellar SH, Michelena HI, Li Z, Schaff HV, Sundt III TM. Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves. Am J Cardiol 2010; 106 (11) 1626-1633
4 Abdulkareem N, Soppa G, Jones S, Valencia O, Smelt J, Jahangiri M. Dilatation of the remaining aorta after aortic valve or aortic root replacement in patients with bicuspid aortic valve: a 5-year follow-up. Ann Thorac Surg 2013; 96 (01) 43-49
5 Hardikar AA, Marwick TH. Surgical thresholds for bicuspid aortic valve associated aortopathy. JACC Cardiovasc Imaging 2013; 6 (12) 1311-1320
6 Charitos EI, Stierle U, Petersen M. et al. The fate of the bicuspid valve aortopathy after aortic valve replacement. Eur J Cardiothorac Surg 2014; 45 (05) e128-e135
7 Kaneko T, Shekar P, Ivkovic V. et al; Bicuspid Aortic Valve Consortium (BAVCon). Should the dilated ascending aorta be repaired at the time of bicuspid aortic valve replacement?. Eur J Cardiothorac Surg 2018; 53 (03) 560-568
8 Lee SH, Kim JB, Kim DH. et al. Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement. J Thorac Cardiovasc Surg 2013; 146 (04) 802-809
9 Reece TB, Singh RR, Stiles BM. et al. Replacement of the proximal aorta adds no further risk to aortic valve procedures. Ann Thorac Surg 2007; 84 (02) 473-478 , discussion 478
10 Girardi LN, Krieger KH, Mack CA, Lee LY, Tortolani AJ, Isom OW. Reoperations on the ascending aorta and aortic root in patients with previous cardiac surgery. Ann Thorac Surg 2006; 82 (04) 1407-1412
11 Borger MA, Fedak PWM, Stephens EH. et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2018; 156 (02) e41-e74
12 Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: an alternative to radical resection. Ann Thorac Surg 1982; 34 (01) 92-94
13 Gardin JM, Adams DB, Douglas PS. et al; American Society of Echocardiography. Recommendations for a standardized report for adult transthoracic echocardiography: a report from the American Society of Echocardiography's Nomenclature and Standards Committee and Task Force for a Standardized Echocardiography Report. J Am Soc Echocardiogr 2002; 15 (03) 275-290
14 Hahn RT, Abraham T, Adams MS. et al; American Society of Echocardiography, Society of Cardiovascular Anesthesiologists. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg 2014; 118 (01) 21-68
15 Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007; 133 (05) 1226-1233
16 Baumgartner H, Falk V, Bax JJ. et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed) 2018; 71 (02) 110
17 Fazel SS, Mallidi HR, Lee RS. et al. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J Thorac Cardiovasc Surg 2008; 135 (04) 901-907 , 907.e1–907.e2
18 Kong WK, Regeer MV, Ng AC. et al. Sex differences in phenotypes of bicuspid aortic valve and aortopathy: Insights from a large multicenter, international registry. Circ Cardiovasc Imaging 2017; 10 (03) 10
19 Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med 2014; 370 (20) 1920-1929
20 Svensson LG, Kim KH, Blackstone EH. et al. Bicuspid aortic valve surgery with proactive ascending aorta repair. J Thorac Cardiovasc Surg 2011; 142 (03) 622-629 , 629.e1–629.e3
21 Rinewalt D, McCarthy PM, Malaisrie SC. et al. Effect of aortic aneurysm replacement on outcomes after bicuspid aortic valve surgery: validation of contemporary guidelines. J Thorac Cardiovasc Surg 2014; 148 (05) 2060-2069
22 Borger MA, Preston M, Ivanov J. et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?. J Thorac Cardiovasc Surg 2004; 128 (05) 677-683
23 Ma WG, Chou AS, Mok SCM. et al. Positive family history of aortic dissection dramatically increases dissection risk in family members. Int J Cardiol 2017; 240: 132-137
24 Dayan V, Zuasnabar A, Citro R. et al; Bicuspid Aortic Valve Consortium – BAVCON. Aortopathy and regurgitation in bicuspid valve patients increase the risk of aortopathy in relatives. Int J Cardiol 2019; 286: 117-120
25 Kong WKF, Regeer MV, Poh KK. et al. Inter-ethnic differences in valve morphology, valvular dysfunction, and aortopathy between Asian and European patients with bicuspid aortic valve. Eur Heart J 2018; 39 (15) 1308-1313
26 Liu F, Yang YN, Xie X. et al. Prevalence of congenital heart disease in Xinjiang multi-ethnic region of China. PLoS One 2015; 10 (08) e0133961
27 Li Y, Wei X, Zhao Z. et al. Prevalence and complications of bicuspid aortic valve in Chinese according to echocardiographic database. Am J Cardiol 2017; 120 (02) 287-291