Effect of bicuspid aortic valve on re-dilatation rate after ascending aortoplasty_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOU Xiaohui

Department of Adult Surgery, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

ZHOU Xiaohui, Email: tempzhou@163.com

Keywords：

Bicuspid aortic valve; ascending aortoplasty; ascending aortic dilatation; ascending aortic aneurysm

DOI：

10.7507/1007-4848.202412057

Video：

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Objective To investigate the impact of bicuspid aortic valve (BAV) on the rate of ascending aortic diameter re-dilatation following ascending aortoplasty. Methods A retrospective analysis was performed on the clinical data of patients who underwent aortic valve replacement (AVR) combined with ascending aortoplasty at Fuwai Hospital between 2010 and 2022. The rate of ascending aortic diameter re-dilatation after remodeling was calculated and compared between patients with tricuspid aortic valve (TAV) and BAV within the longitudinal aortotomy-sandwich technique and external wrapping technique groups. We explored whether BAV affects the rate of diameter re-dilatation after remodeling. Results A total of 84 patients were included, comprising 58 males and 26 females, with a mean age of (54.30±11.36) years (range: 22-76 years). The follow-up duration for all 84 patients ranged from 18.30 to 158.83 months, with a median follow-up time of 42.82 (28.06, 103.12) months. In the longitudinal aortotomy-sandwich technique group (n=47), the rate of re-dilatation ranged from –3.08 to 5.90 mm/year, with a median rate of 0.83 (0.27, 1.44) mm/year. There was no statistical difference in the rate of ascending aortic diameter re-dilatation between patients with TAV and BAV within this group [0.65 (0.34, 1.43) mm/year vs. 0.99 (0.18, 1.44) mm/year, P=0.762]. In the external wrapping technique group (n=37), the rate of re-dilatation ranged from –3.57 to 6.61 mm/year, with a median rate of 0.35 (–0.28, 0.96) mm/year. Similarly, there was no statistical difference in the rate of ascending aortic diameter re-dilatation between patients with TAV and BAV within this group [0.33 (–0.17, 0.77) mm/year vs. 0.58 (–0.28, 1.05) mm/year, P=0.778]. Multivariate analysis revealed that age was an independent protective factor for re-dilatation after the longitudinal aortotomy-sandwich technique (P=0.019), and preoperative ascending aortic diameter was an independent risk factor for re-dilatation after the external wrapping technique (P=0.030). Conclusion BAV does not significantly affect the rate of ascending aortic diameter re-dilatation following ascending aortoplasty.

Citation： ZHOU Xiaohui. Effect of bicuspid aortic valve on re-dilatation rate after ascending aortoplasty. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(9): 1457-1463. doi: 10.7507/1007-4848.202412057 Copy

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2.	Kusner JJ, Brown JY, Gleason TG, et al. The natural history of bicuspid aortic valve disease[J/OL]. Struct Heart, 2022, 7(2): 100119. DOI: 10.1016/j.shj.2022.100119.
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9.	Sillesen AS, V?gg O, Pihl C, et al. Prevalence of bicuspid aortic valve and associated aortopathy in newborns in Copenhagen, Denmark[J]. JAMA, 2021, 325(6): 561-567.
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11.	Fedak PW, David TE, Borger M, et al. Bicuspid aortic valve disease: recent insights in pathophysiology and treatment[J]. Expert Rev Cardiovasc Ther, 2005, 3(2): 295-308.
12.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine[J/OL]. Circulation, 2010, 121(13): e266-e369. DOI: 10.1161/CIR.0b013e3181d4739e.
13.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
14.	Liu S, Shi Y, Liu R, et al. Early prognosis of reduction ascending aortoplasty in patients with aortic valve disease: a single center's experience[J]. Ann Thorac Surg, 2017, 103(2): 511-516.
15.	Guo MH, Appoo JJ, Saczkowski R, et al. Association of mortality and acute aortic events with ascending aortic aneurysm: a systematic review and meta-analysis[J]. JAMA Netw Open, 2018, 1(4): e181281.
16.	Agnese V, Pasta S, Michelena HI, et al. Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: a comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up[J]. J Mol Cell Cardiol, 2019, 135: 31-39.
17.	Zafar MA, Wu J, Vinholo TF, et al. Bicuspid aortopathy does not require earlier surgical intervention[J]. J Thorac Cardiovasc Surg, 2024, 168(3): 760-769.
18.	Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases[J]. Eur Heart J, 2024, 45(36): 3538-3700.
19.	Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta: dilated or not[J]? Scand Cardiovasc J, 2006, 40(3): 175-178.
20.	Patel HJ, Deeb GM. Ascending and arch aorta: pathology, natural history, and treatment[J]. Circulation, 2008, 118(2): 188-195.

1. Bossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes[J]. Nat Rev Cardiol, 2021, 18(5): 331-348.
2. Kusner JJ, Brown JY, Gleason TG, et al. The natural history of bicuspid aortic valve disease[J/OL]. Struct Heart, 2022, 7(2): 100119. DOI: 10.1016/j.shj.2022.100119.
3. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines[J/OL]. Circulation, 2022, 146(24): e334-e482. DOI: 10.1016/j.jacc.2022.08.004.
4. 周曉輝, 關強, 劉睿, 等. 主動脈瓣置換術+升主動脈成形術后升主動脈直徑變化及中遠期臨床結果分析[J]. 中國胸心血管外科臨床雜志, 2023, 30(3): 381-388.Zhou XH, Guan Q, Liu R, et al. Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: aorta diameter change, mid- and long-term clinical results[J]. Chin J Thorac Cardiovasc Surg, 2023, 30(3): 381-388.
5. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease Representative Members, Hiratzka LF, Creager MA, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. J Thorac Cardiovasc Surg, 2016, 151(4): 959-966.
6. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J/OL]. Circulation, 2017, 135(25): e1159-e1195. DOI: 10.1161/CIR.0000000000000503.
7. Li Y, Wei X, Zhao Z, et al. Prevalence and complications of bicuspid aortic valve in Chinese according to echocardiographic database[J]. Am J Cardiol, 2017, 120(2): 287-291.
8. Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: executive summary[J]. J Thorac Cardiovasc Surg, 2018, 156(2): 473-480.
9. Sillesen AS, V?gg O, Pihl C, et al. Prevalence of bicuspid aortic valve and associated aortopathy in newborns in Copenhagen, Denmark[J]. JAMA, 2021, 325(6): 561-567.
10. Nistri S, Sorbo MD, Marin M, et al. Aortic root dilatation in young men with normally functioning bicuspid aortic valves[J]. Heart, 1999, 82(1): 19-22.
11. Fedak PW, David TE, Borger M, et al. Bicuspid aortic valve disease: recent insights in pathophysiology and treatment[J]. Expert Rev Cardiovasc Ther, 2005, 3(2): 295-308.
12. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine[J/OL]. Circulation, 2010, 121(13): e266-e369. DOI: 10.1161/CIR.0b013e3181d4739e.
13. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
14. Liu S, Shi Y, Liu R, et al. Early prognosis of reduction ascending aortoplasty in patients with aortic valve disease: a single center's experience[J]. Ann Thorac Surg, 2017, 103(2): 511-516.
15. Guo MH, Appoo JJ, Saczkowski R, et al. Association of mortality and acute aortic events with ascending aortic aneurysm: a systematic review and meta-analysis[J]. JAMA Netw Open, 2018, 1(4): e181281.
16. Agnese V, Pasta S, Michelena HI, et al. Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: a comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up[J]. J Mol Cell Cardiol, 2019, 135: 31-39.
17. Zafar MA, Wu J, Vinholo TF, et al. Bicuspid aortopathy does not require earlier surgical intervention[J]. J Thorac Cardiovasc Surg, 2024, 168(3): 760-769.
18. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases[J]. Eur Heart J, 2024, 45(36): 3538-3700.
19. Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta: dilated or not[J]? Scand Cardiovasc J, 2006, 40(3): 175-178.
20. Patel HJ, Deeb GM. Ascending and arch aorta: pathology, natural history, and treatment[J]. Circulation, 2008, 118(2): 188-195.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of bicuspid aortic valve on re-dilatation rate after ascending aortoplasty

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