Aortic Dissection After Previous Aortic Valve Replacement for Bicuspid Aortic Valve Disease

Girdauskas, Evaldas; Rouman, Mina; Disha, Kushtrim; Espinoza, Andres; Misfeld, Martín; Borger, Michael A.; Kuntze, Thomas

doi:10.1016/j.jacc.2015.07.022

Cited by 63 publications

(46 citation statements)

References 4 publications

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“…Girdauskas et al 26 showed comparable correlation patterns between functional aortic root parameters and severity/expression of aortopathy in patients with bicuspid versus tricuspid aortic valve stenosis, thereby supporting the fact that aortopathy may be the haemodynamically triggered phenomenon. Recent four-dimensional flow MRI studies showed different helical flow in the aortic root and ascending aorta depending on the valvular morphotype of normofunctional BAV27 28; these eccentric jets lead to a differential distribution of aortic wall shear stress and subsequent vascular remodelling of the aortic wall 23. We found significant aortic root dilation (>45 mm) to be related to age, male sex and significant AR, whereas ascending aorta dilation (>45 mm) was related to age and significant AR and AS, thereby suggesting that haemodynamic abnormalities secondary to valvular dysfunction may produce an additional effect on aorta dilation 29…”

Section: Discussionmentioning

confidence: 99%

Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

Evangelista

Gallego

Calvo-Iglesias

et al. 2017

Heart

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ObjectiveBicuspid aortic valve (BAV) is associated with early valvular dysfunction and proximal aorta dilation with high heterogeneity. This study aimed to assess the determinants of these complications.MethodsEight hundred and fifty-two consecutive adults diagnosed of BAV referred from cardiac outpatient clinics to eight echocardiographic laboratories of tertiary hospitals were prospectively recruited. Exclusion criteria were aortic coarctation, other congenital disorders or intervention. BAV morphotype, significant valve dysfunction and aorta dilation (≥2 Z-score) at sinuses and ascending aorta were established.ResultsThree BAV morphotypes were identified: right–left coronary cusp fusion (RL) in 72.9%, right–non-coronary (RN) in 24.1% and left–non-coronary (LN) in 3.0%. BAV without raphe was observed in 18.3%. Multivariate analysis showed aortic regurgitation (23%) to be related to male sex (OR: 2.80, p<0.0001) and valve prolapse (OR: 5.16, p<0.0001), and aortic stenosis (22%) to BAV-RN (OR: 2.09, p<0.001), the presence of raphe (OR: 2.75, p<0.001), age (OR: 1.03; p<0.001), dyslipidaemia (OR: 1.77, p<0.01) and smoking (OR: 1.63, p<0.05). Ascending aorta was dilated in 76% without differences among morphotypes and associated with significant valvular dysfunction. By contrast, aortic root was dilated in 34% and related to male sex and aortic regurgitation but was less frequent in aortic stenosis and BAV-RN.ConclusionsNormofunctional valves are more prevalent in BAV without raphe. Aortic stenosis is more frequent in BAV-RN and associated with some cardiovascular risk factors, whereas aortic regurgitation (AR) is associated with male sex and sigmoid prolapse. Although ascending aorta is the most commonly dilated segment, aortic root dilation is present in one-third of patients and associated with AR. Remarkably, BAV-RL increases the risk for dilation of the proximal aorta, whereas BAV-RN spares this area.

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Section: Discussionmentioning

confidence: 99%

Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

Evangelista

Gallego

Calvo-Iglesias

et al. 2017

Heart

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“…9 In brief, the following factors were included: diameter of the AA around 45 mm, BSA, sex, age-more progressive decision in young age-fragility of the wall of the AA, progressive increase of AA diameter (0.5 cm per year), family history of aortic disease, BAV type 1 with insufficiency and BAV type 2/unicuspid, phenotype III and IV of AA according to Fazel and colleagues. 16 Age, especially young age, was of special concern for decision making, because age is the most powerful determinant of growth and young age shows faster growth of AA diameters. 4 AOP was performed in borderline dilatation of the lateral AA (Fazel type II), older age, no positive family history, no progressive growth of AA, normalappearing quality of wall-tissue.…”

Section: Surgerymentioning

confidence: 99%

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

Sievers¹,

Stock²,

Stierle³

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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In our study, ascending aorta intervention could be performed with low hospital mortality and obviously did not add to the overall mortality compared with no intervention. Ascending aorta replacement was the most definite intervention. The multifactorial decision for ascending aorta intervention including the z score of the ascending aorta was more liberal in younger patients compared to the simple aortic size guidelines and provided excellent results. However, generalizability needs further data.

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“…The incidence of adverse events was substantially higher in patients with the root phenotype of BAV as opposed to those with BAV/ascending aortic aneurysm and AS (Girdauskas et al, 2012). Girdauskas et al found that patients with BAV-AI had a 10-fold higher risk of post-AVR aortic dissection when compared to patients with BAV-AS (Girdauskas et al, 2015b). A study by Wang et al (2016) found that patients with BAV-AI had a higher prevalence of R-L fusion phenotypes and wider aortic roots than patients with BAV-AS.…”

Section: Resultsmentioning

confidence: 99%

Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement

Norton

Yang

2017

Front. Physiol.

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Bicuspid aortic valve (BAV) can be both sporadic and hereditary, is phenotypically variable, and genetically heterogeneous. The clinical presentation of BAV is diverse and commonly associated with a high prevalence of valvular dysfunction producing altered hemodynamics and aortic abnormalities (e.g., aneurysm and dissection). The thoracic aortic aneurysm (TAA) in BAV frequently involves the proximal aorta, including the aortic root, ascending aorta, and aortic arch, but spares the aorta distal to the aortic arch. While the ascending aortic aneurysm might be affected by both aortopathy and hemodynamics, the aortic root aneurysm is considered to be more of a consequence of aortopathy rather than hemodynamics, especially in younger patients. The management of aortic aneurysm in BAV has been very controversial because the molecular mechanism is unknown. Increasing evidence points toward the BAV root phenotype [aortic root dilation with aortic insufficiency (AI)] as having a higher risk of catastrophic aortic complications. We propose more aggressive surgical approaches toward the BAV with root phenotype.

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Aortic Dissection After Previous Aortic Valve Replacement for Bicuspid Aortic Valve Disease

Cited by 63 publications

References 4 publications

Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement

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