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Management of dilated ascending aorta during aortic valve replacement: Valve replacement alone versus aorta wrapping versus aorta replacement

Authors
 Seung Hyun Lee  ;  Joon Bum Kim  ;  Dong Hee Kim  ;  Sung-Ho Jung  ;  Suk Jung Choo  ;  Cheol Hyun Chung  ;  Jae Won Lee 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.146(4) : 802-809, 2013 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2013
MeSH
Aged ; Aorta/diagnostic imaging ; Aorta/pathology ; Aorta/surgery* ; Aortic Aneurysm/diagnosis ; Aortic Aneurysm/mortality ; Aortic Aneurysm/surgery* ; Aortic Valve/surgery* ; Blood Vessel Prosthesis Implantation*/adverse effects ; Blood Vessel Prosthesis Implantation*/mortality ; Chi-Square Distribution ; Dilatation, Pathologic ; Female ; Heart Valve Diseases/diagnosis ; Heart Valve Diseases/mortality ; Heart Valve Diseases/surgery* ; Heart Valve Prosthesis Implantation*/adverse effects ; Heart Valve Prosthesis Implantation*/mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Time Factors ; Treatment Outcome ; Ultrasonography
Keywords
26.1.3 ; 35.2 ; AVR ; BAV ; CT ; IQR ; LV ; TAV ; aortic valve replacement ; bicuspid aortic valve ; computed tomographic ; interquartile range ; left ventricular ; tricuspid aortic valve
Abstract
OBJECTIVES: The optimal management of dilated ascending aorta during aortic valve replacement (AVR) remains controversial. This study compared the outcomes among 3 different managements (AVR alone, aorta wrapping, and aorta replacement) for the dilated ascending aorta. METHODS: The study enrolled 499 consecutive non-Marfan patients undergoing AVR in the presence of the ascending aorta dilatation (40 to 55 mm). We evaluated rates of death and aortic events; in addition, we evaluated the aortic expansion rate by serial echocardiography. RESULTS: The surgery involved AVR alone (n = 362), aorta wrapping (n = 67), or aorta replacement (n = 70). Early mortality occurred in 1.2% (n = 6, P = .61). Throughout 1590.0 patient-years of follow-up, 47 deaths occurred. The 5-year survival rates were 90.1% ± 2.0%, 91.8% ± 3.5%, and 82.2% ± 7.5% in the AVR alone, aorta wrapping, and aorta replacement groups, respectively (P = .64). One aortic event (acute type A dissection) occurred in the AVR alone group. For the AVR alone group, the median aortic expansion rate was -0.6 mm/y (interquartile range, -3.2 to 0.6 mm/y). The aortic expansion rates were affected neither by the morphology of aortic valves (bicuspid vs tricuspid; P = .10) nor by the initial aorta diameter (γ = -0.31, P = .61). Clinically relevant aortic expansion (≥5 mm/y) was observed only in 5 patients; of these patients, 2 showed the aortic diameter of 60 mm or greater at the end of follow-up. CONCLUSIONS: Compared with concomitant aortic wrapping or replacement, AVR alone achieved similar clinical outcomes, showing considerably low risks of adverse aortic events or relevant aortic expansion in dilated ascending aorta. These findings argue against routine aortic replacement at the time of AVR.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522313006156
DOI
10.1016/j.jtcvs.2013.06.007
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89098
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