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Fate of the Aortic Arch Following Surgery on Aortic Root and Ascending Aorta in Bicuspid Aortic Valve.

Bilkhu, R; Youssefi, P; Soppa, G; Theodoropoulos, P; Phillips, S; Liban, B; Child, A; Tome, M; Nowell, J; Sharma, R; et al. Bilkhu, R; Youssefi, P; Soppa, G; Theodoropoulos, P; Phillips, S; Liban, B; Child, A; Tome, M; Nowell, J; Sharma, R; Edsell, M; Jahangiri, M (2018) Fate of the Aortic Arch Following Surgery on Aortic Root and Ascending Aorta in Bicuspid Aortic Valve. Ann Thorac Surg, 106 (3). pp. 771-776. ISSN 1552-6259 https://doi.org/10.1016/j.athoracsur.2018.03.052
SGUL Authors: Jahangiri, Marjan Tome, Maria Teresa

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Abstract

BACKGROUND: Recent guidelines support more aggressive surgery for aneurysms of the ascending aorta and root in patients with bicuspid aortic valve. However, the fate of the arch after surgery of the root and ascending aorta is unknown. We set out to assess outcomes following root and ascending aortic surgery and subsequent growth of the arch. METHODS: Between 2005 and 2016, 536 consecutive patients underwent surgery for aneurysm of the root and ascending aorta. 168 had bicuspid aortic valve. Patients with dissection were excluded. Arch diameter was measured before and after surgery, at six months and then annually. RESULTS: Of 168 patients, 127 (75.6%) had aortic root replacement and 41 (24.4%) had ascending replacement. Mean age was 57±12.8 years, 82.7% were males and five operations were performed during pregnancy. There was one (0.6%) hospital death. One (0.6%) patient had a stroke and one (0.6%) had re-sternotomy for bleeding. Median ICU and hospital stays were 1 and 6 days respectively. Follow-up was complete for 94% at a median of 5.9 years (1-139 months). Aortic arch diameter was 2.9 cm preoperatively and 3.0 cm at follow-up. There was 97% freedom from reoperation and none of the patients required surgery on the arch. CONCLUSIONS: Prophylactic arch replacement during aortic root and ascending aortic surgery in patients with bicuspid aortic valve is not supported. Our data does not support long term surveillance of the rest of the aorta in this population.

Item Type: Article
Additional Information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: 1103 Clinical Sciences, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ann Thorac Surg
ISSN: 1552-6259
Language: eng
Dates:
DateEvent
September 2018Published
23 April 2018Published Online
19 March 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 29698663
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109802
Publisher's version: https://doi.org/10.1016/j.athoracsur.2018.03.052

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