Abstract
Purpose
Previous aortic valve replacement (AVR) is considered to be an independent risk factor for late acute type A aortic dissection (AAAD). However, the predictors of late AAAD at the time of AVR have not been characterized.
Methods
A total of 285 patients who underwent isolated AVR were followed for 7.6 ± 8.1 years (mean ± SD). These 285 patients were divided into two groups. Group A consisted of 275 patients who did not develop late aortic complications after AVR, and group B consisted of 10 patients (3.5%) who developed late AAAD after AVR.
Results
The mean time interval between initial AVR and developing late AAAD was 6.1 ± 5.2 years. The diameter of the ascending aorta at the time of AVR was significantly greater in group B than those of group A (47.7 ± 4.6 vs. 35.6 ± 6.3 mm; P < 0.001). Univariate analysis identified other predictors as well: aortic regurgitation (P = 0.029), systemic hypertension (P < 0.001), thinning or fragility of the aortic wall (P < 0.001), and male sex (P = 0.039).
Conclusion
Aortic regurgitation combined with systemic hypertension, male sex, and thinned or fragile aortic walls in patients with ascending aortic dilatation (≥45 mm diameter) at the time of AVR may be predisposing factors for postsurgical aortic complications. These patients should be considered for concomitant replacement of the ascending aorta unless the patient has a high operative risk or older age.
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References
Prenger K, Pieters F, Cheriex E. Aortic dissection after aortic valve replacement: incidence and consequences for strategy. J Card Surg 1994;9:495–499.
Borger MA, Preston M, Ivanov J, Fedak PWM, Davierwala P, Armstrong S, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg 2004;128:677–683.
Milano A, Pratali S, De Carlo M, Borzoni G, Tartarini G, Bortolotti U. Ascending aorta dissection after aortic valve replacement. J Heart Valve Dis 1998; 7:75–80.
Von Kodolitsch Y, Simic O, Schwartz A, Dresler C, Loose R, Staudt M, et al. Predictors of proximal aortic dissection at the time of aortic valve replacement. Circulation 1999; 100(suppl):II-287–II-294.
Pieters FAA, Widdershoven JW, Gerardy AC, Geskes G, Cheriex EC, Wellens HJ. Risk of aortic dissection after aortic valve replacement. Am J Cardiol 1993;72:1043–1047.
Hisose H, Svensson LG, Lytle B W, Blackstone EH, Rajeswaran J, Cosgrove DM. Aortic dissection after previous cardiovascular surgery. Ann Thorac Surg 2004;78:2099–2105.
Collins JS, Evangelista A, Nienaber CA, Bossone E, Fang J, Cooper JV, et al. Differences in clinical presentation, management, and outcomes of acute type A aortic dissection in patients with and without previous cardiac surgery. Circulation 2004;110(suppl):II-237–II-242.
Ergin MA, Spielvogel D, Apaydin A, Lansman SL, McCullough JN, Galla JD, et al. Surgical treatment of the dilated ascending aorta: when and how? Ann Thorac Surg 1999;67:1834–1839.
Davies RR, Goldstein LJ, Coady MA, Tittle SL, Rizzo JA, Kopf GS, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 2002;73:17–28.
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Material from this manuscript was presented at the 62nd annual scientific meeting of the Japanese Association of Thoracic Surgery, Yokohama, Kanagawa, Japan, October 2009.
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Tsutsumi, K., Inoue, Y., Hashizume, K. et al. Risk factor analysis for acute type A aortic dissection after aortic valve replacement. Gen Thorac Cardiovasc Surg 58, 601–605 (2010). https://doi.org/10.1007/s11748-010-0658-z
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DOI: https://doi.org/10.1007/s11748-010-0658-z