Skip to main content
SpringerLink
Log in

Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

Aortic dilatation concurrent with aortic valve disease is a common condition. However, the incidence of aortic dissection after aortic valve replacement for tricuspid aortic valve has not been fully investigated. Therefore, we performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve.

Methods

We retrospectively reviewed 599 patients who underwent aortic valve replacement at our hospital between January 2000 and December 2020. We performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve.

Results

Seven patients developed late aortic dissections during the follow-up period. All patients with aortic dissection underwent aortic valve replacement for aortic regurgitation. Multivariable analysis revealed that aortic regurgitation was an independent predictor of aortic dissection (p < 0.0001). The mean ascending aortic diameter at aortic valve replacement for aortic regurgitation was significantly greater in patients with aortic dissection than in those without aortic dissection (46 [43.5–46] mm vs. 39 [36–42] mm, p < 0.001). The predictive cutoff value of ascending aortic diameter was indicated using receiver operating characteristic curve analysis; 46.0 mm (area under the curve: 0.8987). Freedom rates from aortic dissection in patients with aortic regurgitation and an ascending aortic diameter ≥ 46 mm were significantly lower than those in patients with an ascending aortic diameter < 46 mm (66.7% vs. 100% at 5 years, p < 0.0001).

Conclusion

Aortic regurgitation combined with ascending aortic dilatation at aortic valve replacement could be a significant risk factor for late aortic dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Crawford MH, Roldan CA. Prevalence of aortic root dilatation and small aortic roots in valvular aortic stenosis. Am J Cardiol. 2001;87(11):1311–3. https://doi.org/10.1016/s0002-9149(01)01530-2.

    Article  CAS  PubMed  Google Scholar 

  2. Gaudino M, Anselmi A, Morelli M, Pragliola C, Tsiopoulos V, Glieca F, et al. Aortic expansion rate in patients with dilated post-stenotic ascending aorta submitted only to aortic valve replacement long-term follow-up. J Am Coll Cardiol. 2011;58(6):581–4. https://doi.org/10.1016/j.jacc.2011.03.040.

    Article  PubMed  Google Scholar 

  3. Lee SH, Kim JB, Kim DH, Jung SH, Choo SJ, Chung CH, et al. Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement. J Thorac Cardiovasc Surg. 2013;146(4):802–9. https://doi.org/10.1016/j.jtcvs.2013.06.007.

    Article  PubMed  Google Scholar 

  4. Estrera AL, Miller CC, Kaneko T, Lee TY, Walkes JC, Kaiser LR, et al. Outcomes of acute Type A aortic dissection after previous cardiac surgery. Ann Thorac Surg. 2010;89:1467–74. https://doi.org/10.1016/j.athoracsur.2010.02.015.

    Article  PubMed  Google Scholar 

  5. Özçınar E, Çakıcı M, Baran Ç, Gümüş F, Özgür A, Yazıcıoğlu L, et al. Results of late-onset type A aortic dissection after previous cardiac surgery: does prior coronary artery bypass grafting affect survival? Turk Gogus Kalp Damar Cerrahisi Derg. 2018;26:1–7. https://doi.org/10.5606/tgkdc.dergisi.2018.14683.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Klodell CT, Karimi A, Beaver TM, Hess PJ, Martin TD. Outcomes for acute type A aortic dissection: effects of previous cardiac surgery. Ann Thorac Surg. 2012;93:1206–14. https://doi.org/10.1016/j.athoracsur.2011.12.076.

    Article  PubMed  Google Scholar 

  7. Borger MA, Preston M, Ivanov J, Fedak PW, 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;128:677–83. https://doi.org/10.1016/j.jtcvs.2004.07.009.

    Article  PubMed  Google Scholar 

  8. Itagaki S, Chikwe JP, Chiang YP, Egorova NN, Adams DH. Long-term risk for aortic complications after aortic valve replacement in patients with bicuspid aortic valve versus Marfan syndrome. J Am Coll Cardiol. 2015;65:2363–9. https://doi.org/10.1016/j.jacc.2015.03.575.

    Article  PubMed  Google Scholar 

  9. Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J. 2020;84:2037–119. https://doi.org/10.1253/circj.CJ-20-0135.

    Article  PubMed  Google Scholar 

  10. Wang Y, Wu B, Li J, Dong L, Wang C, Shu X. Impact of aortic insufficiency on ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement in patients with a bicuspid aortic valve. Ann Thorac Surg. 2016;101:1707–14. https://doi.org/10.1016/j.athoracsur.2015.10.047.

    Article  PubMed  Google Scholar 

  11. Girdauskas E, Rouman M, Disha K, Espinoza A, Misfeld M, Borger MA, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease. J Am Coll Cardiol. 2015;66:1409–11. https://doi.org/10.1016/j.jacc.2015.07.022.

    Article  PubMed  Google Scholar 

  12. 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 2):287–94. https://doi.org/10.1161/01.cir.100.suppl_2.ii-287.

    Article  Google Scholar 

  13. Tsutsumi K, Inoue Y, Hashizume K, Kimura N, Takahashi R. Risk factor analysis for acute type A aortic dissection after aortic valve replacement. Gen Thorac Cardiovasc Surg. 2010;58:601–5. https://doi.org/10.1007/s11748-010-0658-z.

    Article  PubMed  Google Scholar 

  14. Sequeira Gross TM, Lindner D, Ojeda FM, Neumann J, Grewal N, Kuntze T, et al. Comparison of microstructural alterations in the proximal aorta between aortic stenosis and regurgitation. J Thorac Cardiovasc Surg. 2021;162:1684–95. https://doi.org/10.1016/j.jtcvs.2020.03.002.

    Article  PubMed  Google Scholar 

  15. Roberts WC, Vowels TJ, Ko JM, Filardo G, Hebeler RF Jr, Henry AC, et al. Comparison of the structure of the aortic valve and ascending aorta in adults having aortic valve replacement for aortic stenosis versus for pure aortic regurgitation and resection of the ascending aorta for aneurysm. Circulation. 2011;123:896–903. https://doi.org/10.1161/CIRCULATIONAHA.110.972406.

    Article  PubMed  Google Scholar 

  16. Benedik J, Pilarzcyk K, Wendt D, Price V, Tsagakis K, Perrey M, et al. Is there any difference in aortic wall quality between patients with aortic stenosis and those with regurgitation? Eur J Cardiothorac Surg. 2013;44:754–9. https://doi.org/10.1093/ejcts/ezt123.

    Article  PubMed  Google Scholar 

  17. Balint B, Federspiel JM, Schwab T, Ehrlich T, Ramsthaler F, Schäfers HJ. Aortic regurgitation is associated with ascending aortic remodeling in the nondilated aorta. Arterioscler Thromb Vasc Biol. 2021;41:1179–90. https://doi.org/10.1161/ATVBAHA.120.315739.

    Article  CAS  PubMed  Google Scholar 

  18. van Ooij P, Markl M, Collins JD, Carr JC, Rigsby C, Bonow RO, et al. Aortic valve stenosis alters expression of regional aortic wall shear stress: new insights from a 4-dimensional flow magnetic resonance imaging study of 571 subjects. J Am Heart Assoc. 2017;6:e005959. https://doi.org/10.1161/JAHA.117.005959.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Girdauskas E, Rouman M, Disha K, Scholle T, Fey B, Theis B, et al. Correlation between systolic transvalvular flow and proximal aortic wall changes in bicuspid aortic valve stenosis. Eur J Cardiothorac Surg. 2014;46:234–9. https://doi.org/10.1093/ejcts/ezt610.

    Article  PubMed  Google Scholar 

  20. Guzzardi DG, Barker AJ, van Ooij P, Malaisrie SC, Puthumana JJ, Belke DD, et al. Valve-related hemodynamics mediate human bicuspid aortopathy: insights from wall shear stress mapping. J Am Coll Cardiol. 2015;66:892–900. https://doi.org/10.1016/j.jacc.2015.06.1310.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shan Y, Li J, Wang Y, Wu B, Barker AJ, Markl M, et al. Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency. J Thorac Cardiovasc Surg. 2017;153:1263-72.e1. https://doi.org/10.1016/j.jtcvs.2016.12.059.

    Article  PubMed  PubMed Central  Google Scholar 

  22. van Ooij P, Potters WV, Nederveen AJ, Allen BD, Collins J, Carr J, et al. A methodology to detect abnormal relative wall shear stress on the full surface of the thoracic aorta using four-dimensional flow MRI. Magn Reson Med. 2015;73:1216–27. https://doi.org/10.1002/mrm.25224.

    Article  PubMed  Google Scholar 

  23. Bieging ET, Frydrychowicz A, Wentland A, Landgraf BR, Johnson KM, Wieben O, et al. In vivo three-dimensional MR wall shear stress estimation in ascending aortic dilatation. J Magn Reson Imaging. 2011;33:589–97. https://doi.org/10.1002/jmri.22485.

    Article  PubMed  Google Scholar 

  24. Bürk J, Blanke P, Stankovic Z, Barker A, Russe M, Geiger J, et al. Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR. J Cardiovasc Magn Reson. 2012;14:84. https://doi.org/10.1186/1532-429X-14-84.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan

    Yuki Tamagawa, Masashi Kawamura, Kana Shibata, Satoshi Asada, Masahiro Ryugo, Yasush i Tsutsumi & Osamu Monta

Authors
  1. Yuki Tamagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masashi Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kana Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoshi Asada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Ryugo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasush i Tsutsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Osamu Monta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masashi Kawamura.

Ethics declarations

Conflict of interest

None declared.

Ethical approval

This study was approved by the local Institutional Review Board (number: 2023-021 date: February 6, 2023), and informed consent was obtained from all patients in this study. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamagawa, Y., Kawamura, M., Shibata, K. et al. Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. Gen Thorac Cardiovasc Surg 72, 305–310 (2024). https://doi.org/10.1007/s11748-023-01970-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-023-01970-3

Keywords

Search

Navigation