Fate of preserved bicuspid valves at time of ascending aortic aneurysmectomy

Vinholo, Thais Faggion; Zafar, Mohammad A.; Baldwin, Grace; Buntin, Joelle; Mansour, Ahmed M.; Imran, Mahnoor; Papanikolaou, Dimitra; Ziganshin, Bulat A.; Elefteriades, John A.

doi:10.1111/jocs.14024

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…Similarly, Russo et al 5,6 analyzing a cohort of 40 patients undergoing supracoronary ascending aorta replacement with normally functioning BAV reported that, after a mean follow‐up 93 ± 50 months, only 4 patients required AVR, 3 for aortic regurgitation and 1 for aortic stenosis and at 10 years, they reported that freedom from cardiac death was 83 ± 16%. Likewise, Vinholo et al 7 published the long‐term (mean echocardiography follow‐up 4.50 ± 4.09 years) results of 23 patients with none or trace of aortic regurgitation or stenosis who underwent ascending aorta replacement without AVR. In this group, five patients showed a progression of the aortic regurgitation or stenosis from none to mild and two patients from none to severe.…”

Section: Commentmentioning

confidence: 99%

“…Within thoracic aortic aneurysms in BAV patients, supra‐coronary aneurysm is the prevalent phenotype (60%–70% of dilatated aortas) 2,3 . In patients with normal functioning BAV and supracoronary ascending aorta aneurysm the 2017 European Guidelines 4 advise for isolated ascending aorta replacement, and two recent studies confirm good long‐term function of the BAV 5‐7 . However, in patients undergoing supracoronary ascending aorta replacement with concomitant mild‐to moderate BAV diseases, the indication to aortic valve replacement (AVR) is still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

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Fate of mild‐to‐moderate bicuspid aortic valve disease untreated during ascending aorta replacement

et al. 2021

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Background Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods From June 2002 to January 2020, 75 patients with mild‐to‐moderate BAV regurgitation (±mild‐to‐moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyzed. Clinical and echocardiographic follow‐up was 100% complete (mean: 7.4 ± 3.9 years, max: 16.4). Kaplan–Meier estimates were employed to analyze long‐term survival. Cumulative incidence function (CIF) for time to reoperation, recurrence of aortic regurgitation (AR) ≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4 ± 2.5%, 95% confidence interval (CI: 83.16–99.63). At follow‐up there were no cases of aortic root surgery whereas three patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6 ± 2.5%, 95% CI [0.20–11.53]. At follow‐up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR more than 2+/4+ was 5.1 ± 4.98% and of AS more than moderate 6.9 ± 3.8%. Conclusions In our study mild to moderate regurgitation of a BAV did not do significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

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Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fate of mild‐to‐moderate bicuspid aortic valve disease untreated during ascending aorta replacement

et al. 2021

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Fate of preserved bicuspid valves at time of ascending aortic aneurysmectomy

et al. 2019

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We read with great interest the recently published paper from Faggion Vinholo and coworkers, in which the authors described their experience in the treatment of 23 patients affected by ascending aorta aneurysm in presence of a normally functioning bicuspid aortic valve (BAV). 1In all cases no significant BAV abnormalities were observed and, therefore, a sparing approach with isolated supra-coronary aorta replacement was adopted. During a mean follow-up of 4.50 ± 4.09 years, two patients experienced a new onset moderate-severe BAV dysfunction, with one case who needed for redo aortic valve replacement.Patients affected by BAV aortopathy represent a heterogeneous population in which both genetics and hemodynamic factors play a special role in the pathogenesis of proximal aorta dilatation. Several studies reported the natural history of BAV, but the decision whether to preserve a congenitally altered valve, exposing the patient to the risk of aortic valve reintervention, or to replace the valve prophylactically at the time of proximal aorta surgery, remains debated. 2 We have previously reported in a series of 40 BAV patients undergoing isolated ascending aorta replacement, freedom from aortic valve replacement of 100% and 90% ± 10% at 5 and 10 years, respectively. 3,4 In this studied population we described that almost half of the patients had type 0 BAV according to Sievers' criteria, speculating the presence of a particular phenotype of BAV aortopathy in which type 0 BAV was associated with an isolated ascending aorta aneurysm.Moreover, we have reported a successful approach with a transcatheter solution aortic valve implantation (TAVI) for the treatment of late aortic valve stenosis in a patient with BAV and previously treated with isolated ascending aorta replacement. 5 In the present paper, the authors reported a single patient with previous associated coronary artery bypass grafting surgery who underwent reoperation.We are interested in the authorʼs experience regarding the two fore mentioned aspects. Did they notice any similar correlation with BAV types and aneurysm phenotype? And which criteria did they select for redo surgery vs TAVI procedure in this complex scenario?ORCID Monica Greci

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Fate of preserved bicuspid valves at time of ascending aortic aneurysmectomy

Cited by 2 publications

References 15 publications

Fate of mild‐to‐moderate bicuspid aortic valve disease untreated during ascending aorta replacement

Fate of mild‐to‐moderate bicuspid aortic valve disease untreated during ascending aorta replacement

Fate of preserved bicuspid valves at time of ascending aortic aneurysmectomy

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