Objective

The appropriate timing of aortic repair in patients with bicuspid aortic valve-related aortopathy remains controversial. We describe the changes in diameter of the non-aneurysmal ascending aorta after aortic valve replacement for bicuspid or tricuspid aortic valve stenosis.

Methods

This retrospective review included 189 patients who had undergone aortic valve replacement for severe stenotic aortic valve with a non-aneurysmal ascending aorta diameter of 45 mm or less between January 2008 and December 2018. A linear mixed-effect model was used to analyze and compare the enlargement rates of the non-aneurysmal ascending aorta at the tubular portion after aortic valve replacement in bicuspid and tricuspid aortic valve patients.

Results

The enlargement rate of the non-aneurysmal ascending aorta after aortic valve replacement was significantly greater in the bicuspid aortic valve group than in the tricuspid aortic valve group (0.36 mm/year vs. 0.09 mm/year, p < 0.001). The specific form of bicuspid aortic valve also affected aorta diameter enlargement: the enlargement rate of 0.85 mm/year in the Type 0 (according to Sievers’ classification) group was approximately five times that in the Non-Type 0 group (p < 0.001). No aortic events were observed, and no patients needed reoperations for the ascending aorta, in either the bicuspid or tricuspid aortic valve groups.

Conclusion

The persistent possibility of progressive ascending aortic dilatation after aortic valve replacement for bicuspid aortic valve stenosis, especially in Type 0 bicuspid aortic valve patients, demands careful post-procedural evaluation of the ascending aorta.

中文翻译：

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二尖瓣和三尖瓣狭窄患者主动脉瓣置换术后非动脉瘤性升主动脉内径变化

客观的

二叶主动脉瓣相关性主动脉病患者主动脉修复的适当时机仍存在争议。我们描述了主动脉瓣置换术治疗二尖瓣或三尖瓣狭窄后非动脉瘤性升主动脉直径的变化。

方法

这项回顾性研究纳入了 2008 年 1 月至 2018 年 12 月期间因非动脉瘤性升主动脉直径≤45 mm 的严重狭窄主动脉瓣进行主动脉瓣置换术的 189 例患者。使用线性混合效应模型分析和比较二尖瓣和三尖瓣患者主动脉瓣置换术后管状部分非动脉瘤性升主动脉的扩大率。

结果

二尖瓣组主动脉瓣置换术后非动脉瘤性升主动脉的扩大率明显高于三尖瓣组（0.36 mm/年 vs. 0.09 mm/年，p  < 0.001）。二尖瓣的具体形式也影响主动脉直径扩大：0型（根据Sievers分类）组的0.85 mm/年的扩大率约为非0型组的5倍（p  < 0.001） . 在二尖瓣或三尖瓣主动脉瓣组中均未观察到主动脉事件，也没有患者需要对升主动脉进行再次手术。

结论

主动脉瓣置换术治疗二叶主动脉瓣狭窄后，持续存在进行性升主动脉扩张的可能性，特别是在 0 型二叶主动脉瓣患者中，需要对升主动脉进行仔细的术后评估。