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Long-term Fate of Dilated Ascending Aorta after Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Disease

 Min-Seok Kim  ;  Jung Hwan Kim  ;  Seung Hyun Lee  ;  Sak Lee  ;  Young-Nam Youn  ;  Kyung-Jong Yoo  ;  Hyun-Chel Joo 
 AMERICAN JOURNAL OF CARDIOLOGY, Vol.129 : 53-59, 2020-08 
Journal Title
Issue Date
Aorta / diagnostic imaging* ; Aortic Aneurysm / complications ; Aortic Aneurysm / diagnostic imaging ; Aortic Diseases / complications ; Aortic Diseases / diagnostic imaging* ; Aortic Valve / abnormalities* ; Aortic Valve / surgery ; Aortic Valve Insufficiency / complications ; Aortic Valve Insufficiency / surgery* ; Aortic Valve Stenosis / complications ; Aortic Valve Stenosis / surgery* ; Bicuspid Aortic Valve Disease ; Case-Control Studies ; Dilatation, Pathologic / complications ; Dilatation, Pathologic / diagnostic imaging ; Disease Progression ; Female ; Heart Valve Diseases / complications ; Heart Valve Diseases / surgery* ; Heart Valve Prosthesis Implantation ; Humans ; Logistic Models ; Male ; Postoperative Complications ; Propensity Score ; Proportional Hazards Models
We compared the long-term outcomes and difference in dilatation rates of the ascending aorta after aortic valve (AV) replacement (AVR) between bicuspid and tricuspid AV patients, and evaluated risk factors associated with ascending aorta dilatation and aortic events during the follow-up. Of 1,127 patients who underwent AVR from 1995 to 2015, 259 patients with a dilated ascending aorta (≥40 mm in diameter) were included. The patients were divided into those with bicuspid (group bicuspid aortic valve [BAV], n = 105) and with tricuspid (group tricuspid aortic valve [TAV], n = 154) AV, and a propensity score-matched analysis was performed to match 98 patients in each group. The differences in the dilation rate of the ascending aorta and long-term outcomes were analyzed. Risk factors for ascending aorta dilatation, mortality, and aortic events were identified. Follow-up was completed in 100% of patients with a median follow-up duration of 106.1 [68.8, 163.0] months. The early clinical outcomes and dilation rate of the ascending aorta were similar between the groups. Overall survivals up to 15 years postoperatively were similar between groups BAV and TAV (p = 0.223). Aortic events occurred in 6 patients (groups BAV vs TAV, 2 vs 4;p = 0.678). Preoperative ascending aorta diameter showed a linear relationship with the dilatation rate of ascending aorta (p <0.001) and was related to progressive aortic dilatation and aortic events (odds ratio: 1.25, p <0.001 and hazard ratio = 1.56, p <0.001, respectively). In conclusion, the long-term outcomes and ascending aorta dilatation rate were similar between the BAV and TAV patients up to 15 years after AVR. Bicuspid AV was not a risk factor of mortality or aortic events.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min-Seok(김민석)
Kim, Jung Hwan(김정환)
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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