Surgical Treatment of Patients with a Bicuspid Aortic Valve and Concomitant Expansion of the Ascending Aorta

DOI: https://doi.org/10.30702/ujcvs/23.31(01)/TP003-5359
Keywords: aortic valve replacement, long-term results, ascending aorta aneurysm, aortic dissection

Abstract

The aim. To evaluate the rate of long-term complications on ascending aorta after bicuspid aortic valve (BAV) replacement depending on the type of defect (stenosis or insufficiency) and to determine the indications to certain type of surgery in this category of patients.

Materials and methods. One hundred five patients underwent BAV replacement between 2007 and 2014. The patients were divided into two groups. Group 1 included 63 patients with stenosis prevalence, group 2 included 42 patients with insufficiency. Aortic diameter at the level of the sinuses of Valsalva and at the level of the ascending aorta was assessed preoperatively and in the long-term postoperative period.

Results. Long-term results were studied in 86 (81.9%) patients during 6.8 ± 2.2 years at the average. Sixteen (18.6%) patients developed aortic complications: 6 (6.9%) of them had progressive dilatation (10% from initial diameter), aneurysm formation was detected in 8 cases (9.3%) with 6 cases (6.9%) of dissection, 1 patient (1.3%) had aortic rupture. Freedom from ascending aorta dilatation within 13 years after BAV replacement was 95.1% in group 1 and 62.3% in group 2. Freedom from aortic dissection within 13 years after BAV replacement was 90.1% at the average (97% in group 1 and 80.6% in group 2).

Conclusion. The tactics of aortic aneurysm correction in BAV depends on its diameter and, to a lesser extent, on the presence of stenosis or insufficiency of the valve. With existing stenosis and a diameter of the ascending aorta up to 4.5 cm, it is possible to consider correction without intervention on the ascending aorta. The presence of valve insufficiency in such a situation often requires additional manipulations on the ascending aorta.

References

  1. Kravchenko IN, Sytar LL, Knyshov GV, Zakharova VP, Kravchenko VI, Komar II, et al. [The state of the aorta and of the aortic valve in bicuspid aortic valve disease]. A Yearbook of Scientific Papers of the Association of cardiovascular surgeons of Ukraine. 2010;(18):328-330. Russian.
  2. Ali A, Patel A, Ali ZA, Abu-Omar Y, Freed D, Sheikh AY, et al. Stentless aortic valve replacement in patients with bicuspid aortic valve disease: clinical outcome and aortic diameter changes during follow-up. Eur J Cardiothorac Surg. 2010;38(2):134-40. https://doi.org/10.1016/j.ejcts.2010.01.039
  3. Andreassi MG, Della Corte A. Genetics of bicuspid aortic valve aortopathy. Curr Opin Cardiol. 2016;31(6):585-92. https://doi.org/10.1097/HCO.0000000000000328
  4. Bekkers JA, Raap GB, Takkenberg JJ, Bogers AJ. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg. 2013;43(2):389-96. https://doi.org/10.1093/ejcts/ezs342
  5. Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg. 2018;156(2):e41-e74. https://doi.org/10.1016/j.jtevs.2018.02.115
  6. Bravo-Jaimes K, Prakash SK. Genetics in bicuspid aortic valve disease: Where are we? Prog Cardiovasc Dis. 2020;63(4):398-406. https://doi.org/10.1016/j.pcad.2020.06.005
  7. Cotrufo M, Della Corte A. The association of bicuspid aortic valve disease with asymmetric dilatation of the tubular ascending aorta: identification of a definite syndrome. J Cardiovasc Med (Hagerstown). 2009;10(4):291-7. https://doi.org/10.2459/JCM.0b013e3283217e29
  8. Dayan V, Cura L, Muñoz L, Areco D, Ferreiro A, Pizzano N. Risk of subsequent aortic dilatation is low in patients with bicuspid aortic valve and normal aortic root diameter at the time of aortic valve replacement. Interact Cardiovasc Thorac Surg. 2010;10(4):535-8. https://doi.org/10.1510/icvts.2009.216333
  9. Fulmer D, Toomer K, Guo L, Moore K, Glover J, Moore R, et al. Defects in the Exocyst-Cilia Machinery Cause Bicuspid Aortic Valve Disease and Aortic Stenosis. Circulation. 2019;140(16):1331-41. https://doi.org/10.1161/CIRCULATIONAHA.119.038376
  10. Galian-Gay L, Carro Hevia A, Teixido-Turà G, Rodríguez Palomares J, Gutiérrez-Moreno L, Maldonado G, et al.; BICUSPID investigators. Familial clustering of bicuspid aortic valve and its relationship with aortic dilation in first-degree relatives. Heart. 2019;105(8):603-8. https://doi.org/10.1136/heartjnl-2018-313802
  11. Gillis E, Kumar AA, Luyckx I, Preuss C, Cannaerts E, van de Beek G, et al.; Mibava Leducq Consortium. Candidate Gene Resequencing in a Large Bicuspid Aortic Valve- Associated Thoracic Aortic Aneurysm Cohort: SMAD6 as an Important Contributor. Front Physiol. 2017;8:400. https://doi.org/10.3389/fphys.2017.00400. Erratum in: Front Physiol. 2017;8:730.
  12. Girdauskas E, Borger MA, Secknus MA, Girdauskas G, Kuntze T. Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument. Eur J Cardiothorac Surg. 2011;39(6):809-14. https://doi.org/10.1016/j.ejcts.2011.01.001
  13. Goland S, Czer LS, De Robertis MA, Mirocha J, Kass RM, Fontana GP, et al. Risk Factors Associated With Reoperation and Mortality in 252 Patients After Aortic Valve Replacement for Congenitally Bicuspid Aortic Valve Disease. Ann Thorac Surg. 2007;83(3):931-7. https://doi.org/10.1016/j.athoracsur.2006.10.047
  14. Fatehi Hassanabad A, Feindel CM, Verma S, Fedak PWM. Evolving Surgical Approaches to Bicuspid Aortic Valve Associated Aortopathy. Front Cardiovasc Med. 2019;6:19. https://doi.org/10.3389/fcvm.2019.00019
  15. Helgadottir A, Thorleifsson G, Gretarsdottir S, Stefansson OA, Tragante V, Thorolfsdottir RB, et al. Genome-wide analysis yields new loci associating with aortic valve stenosis. Nat Commun. 2018;9(1):987. https://doi.org/10.1038/s41467-018-03252-6
  16. Luyckx I, Kumar AA, Reyniers E, Dekeyser E, Vanderstraeten K, Vandeweyer G, et al.; MIBAVA Leducq Consortium. Copy number variation analysis in bicuspid aortic valve- related aortopathy identifies TBX20 as a contributing gene. Eur J Hum Genet. 2019;27(7):1033-43. https://doi.org/10.1038/s41431-019-0364-y
  17. Matsuyama K, Usui A, Akita T, Yoshikawa M, Murayama M, Yano T, et al. Natural History of a Dilated Ascending Aorta After Aortic Valve Replacement. Circ J. 2005;69(4):392-6. https://doi.org/10.1253/circj.69.392
  18. McKellar SH, Michelena HI, Li Z, Schaff HV, Sundt TM 3rd. Long-Term Risk of Aortic Events Following Aortic Valve Replacement in Patients With Bicuspid Aortic Valves. Am J Cardiol. 2010;106(11):1626-33. https://doi.org/10.1016/j.amjcard.2010.07.043
  19. Nakanishi T, Markwald RR, Baldwin HS, Keller BB, Srivastava D, Yamagishi H, editors. Etiology and Morphogenesis of Congenital Heart Disease: From Gene Function and Cellular Interaction to Morphology. Tokyo: Springer; 2016. p. 371-376. https://doi.org/10.1007/978-4-431-54628-3
  20. Prakash SK, Bossé Y, Muehlschlegel JD, Michelena HI, Limongelli G, Della Corte A, et al.; BAVCon Investigators. A Roadmap to Investigate the Genetic Basis of Bicuspid Aortic Valve and its Complications: Insights From the International BAVCon (Bicuspid Aortic Valve Consortium). J Am Coll Cardiol. 2014;64(8):832-9. https://doi.org/10.1016/j.jacc.2014.04.073
  21. Russo CF, Mazzetti S, Garatti A, Ribera E, Milazzo A, Bruschi G, et al. Aortic complications after bicuspid aortic valve replacement: long-term results. Ann Thorac Surg. 2002;74(5):S1773-6; discussion S1792-9. https://doi.org/10.1016/s0003-4975(02)04261-3
  22. Silva J, Maroto LC, Carnero M, Vilacosta I, Cobiella J, Villagrán E, et al. Ascending Aorta and Aortic Root Reoperations: Are Outcomes Worse Than First Time Surgery? Ann Thorac Surg. 2010;90(2):555-60. https://doi.org/10.1016/j.athoracsur.2010.03.092
  23. Siu SC, Silversides CK. Bicuspid Aortic Valve Disease. J Am Coll Cardiol. 2010;55(25):2789-800. https://doi.org/10.1016/j.jacc.2009.12.068
  24. Sinning C, Zengin E, Kozlik-Feldmann R, Blankenberg S, Rickers C, von Kodolitsch Y, et al. Bicuspid aortic valve and aortic coarctation in congenital heart disease-important aspects for treatment with focus on aortic vasculopathy. Cardiovasc Diagn Ther. 2018;8(6):780-8. https://doi.org/10.21037/cdt.2018.09.20
  25. Szeto WY, Bavaria JE, Bowen FW, Geirsson A, Cornelius K, Hargrove WC, et al. Reoperative Aortic Root Replacement in Patients With Previous Aortic Surgery. Ann Thorac Surg. 2007;84(5):1592-8; discussion 1598-9. https://doi.org/10.1016/j.athoracsur.2007.05.049
  26. Tobin SW, Alibhai FJ, Lee MM, Yeganeh A, Wu J, Li SH, et al. Novel mediators of aneurysm progression in bicuspid aortic valve disease. J Mol Cell Cardiol. 2019;132:71-83. https://doi.org/10.1016/j.yjmcc.2019.04.022
  27. Yasuda H, Nakatani S, Stugaard M, Tsujita-Kuroda Y, Bando K, Kobayashi J, et al. Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve. Circulation. 2003;108 Suppl 1:II291-4. https://doi.org/10.1161/01.cir.0000087449.03964.fb
Published
2023-03-27
How to Cite
Trembovetska, O. M., Pantas, O. V., Kravchenko, V. I., Kravchenko, I. M., & Osadovska, I. A. (2023). Surgical Treatment of Patients with a Bicuspid Aortic Valve and Concomitant Expansion of the Ascending Aorta. Ukrainian Journal of Cardiovascular Surgery, 31(1), 53-59. https://doi.org/10.30702/ujcvs/23.31(01)/TP003-5359
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 31 No 1 2023
Section
PATHOLOGY OF AORTA

Most read articles by the same author(s)