AI Article Synopsis
- - Recent guidelines advocate for more aggressive surgery in patients with bicuspid aortic valves suffering from aneurysms of the ascending aorta and root, but the impact on the aortic arch post-surgery is unclear.
- - A study involving 536 patients showed that 168 had bicuspid aortic valves; aortic arch sizes were monitored before and after surgeries for growth over time, with a high rate of successful outcomes.
- - Results indicated that prophylactic surgery on the aortic arch is unnecessary, as significant changes in arch size were not observed, suggesting long-term monitoring of the aorta in these patients may not be needed.
Article Abstract
Background: Recent guidelines support more aggressive surgery for aneurysms of the ascending aorta and root in patients with bicuspid aortic valve. However, the fate of the arch after surgery of the root and ascending aorta is unknown. We set out to assess outcomes following root and ascending aortic surgery and subsequent growth of the arch.
Methods: Between 2005 and 2016, 536 consecutive patients underwent surgery for aneurysm of the root and ascending aorta; 168 had bicuspid aortic valve. Patients with dissection were excluded. Arch diameter was measured before and after surgery, at 6 months and then annually.
Results: Of 168 patients, 127 (75.6%) had aortic root replacement and 41 (24.4%) had ascending replacement. Mean age was 57 ± 12.8 years, 82.7% were men, and 5 operations were performed during pregnancy. There was 1 (0.6%) hospital death. One (0.6%) patient had a stroke and 1 (0.6%) had resternotomy for bleeding. Median intensive care unit and hospital stays were 1 and 6 days, respectively. Follow-up was complete for 94% at a median of 5.9 years (range, 1 to 139 months). Aortic arch diameter was 2.9 cm preoperatively and 3.0 cm at follow-up. There was 97% freedom from reoperation and none of the patients required surgery on the arch.
Conclusions: 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.
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| http://dx.doi.org/10.1016/j.athoracsur.2018.03.052 | DOI Listing |
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