Fate of the Aortic Arch Following Surgery on the Aortic Root and Ascending Aorta in Bicuspid Aortic Valve

Abstract

Prophylactic arch replacement during aortic root and ascending aortic surgery in patients with bicuspid aortic valve is not supported. Our data do not support long-term surveillance of the rest of the aorta in this population.

Life Expectancy after Surgery for Ascending Aortic Aneurysm

“…The RS by year of follow-up did not identify any year with an excess of mortality due to the disease indicating that the operation completely recovered their life expectancy. With perioperative mortality for isolated ascending aortic replacement of less than 1% reported in some recent studies [9,21], this finding gives an incredibly promising scenario from which we can infer that the aneurysm of the ascending aorta is nowadays a condition that does not have to affect long-term survival. In addition, the risk of a late complication associated with the aorta was very low (only 3 patients, 0.43%) indicating that the aorta is no longer a problem in these patients.…”

Invited Commentary

“…Without a better understanding of the risks of later degeneration, many of our patients will continue to undergo imaging, with its attendant risks of radiation and renal dysfunction, on the basis of fear rather than data. As for the disagreement on surveillance expressed by Bilkhu and associates [1], their article does not provide adequate ammunition for us to concede.…”

“…Bilkhu and colleagues [1] have added to the discussion of this issue by following up a controversial subset of patients with bicuspid aortic valve who underwent aortic root or ascending aorta operations. At almost 6 years of follow-up, Bilkhu and colleagues [1] found minimal growth in the aortic arches of these patients with a 94% follow-up. Of their 168 patients, 5 patients required reintervention for aortic root or valve indications that presumably were identified by echocardiography alone.…”

“…The need for surveillance remains elusive, but this well-done study by Bilkhu and associates [1] demonstrates the need for more information about the optimal mode of surveillance of patients after proximal aortic intervention. Without a better understanding of the risks of later degeneration, many of our patients will continue to undergo imaging, with its attendant risks of radiation and renal dysfunction, on the basis of fear rather than data.…”

Commentary: In the absence of convincing evidence, more is not better

“…The authors cite studies that followed bicuspid aortic valve patients at a mean 4-to 5-year follow up after aortic valve and ascending aortic replacement. 2,[5][6][7][8] None of these studies demonstrated instances of reoperation for aneurysmal degeneration when abiding by a more conservative surgical approach.…”