Bicuspid Aortic Valve Resuspension in Acute Type A Aortic Dissection Patients.

Abstract

There are no data on the fate of the preserved bicuspid aortic valve (BAV) in patients with acute type A aortic dissection. We investigated surgical outcomes in BAV patients who had undergone aortic valve resuspension versus replacement for dissection type A. Among 1,500 consecutive patients operated on for acute type A dissection between 1993 and 2013 at 3 tertiary centers, 66 had BAV (68% males, median age 60 ± 15 years). Thirteen BAV resuspension patients were compared with 53 BAV replacement patients. Median follow-up was 5.0 ± 4.7 years. The ages of both groups were similar (resuspension 62 ± 13 vs replacement 57 ± 15 years, p = 0.62), and both presented similar risk-factor profiles. Moderate-to-severe aortic valve regurgitation was observed in 15% of the resuspension and 45% of the replacement patients (p = 0.06). Resuspension patients required shorter cardiopulmonary bypass and cross-clamp times (153 ± 48 vs 224 ± 76 min, p < 0.01; 106 ± 33 vs 172 ± 57 min, p < 0.01, respectively). In-hospital mortality was observed in 15.4% of the resuspension and 15.1% of the replacement patients (p = 1). One replacement patient underwent a proximal reoperation. The resuspension group experienced no severe aortic regurgitation, nor any need for proximal reintervention. Overall survival was 68% ± 13% vs 65% ± 7% at 5 years in resuspension and replacement groups, respectively (log- rank, p = 0.97). The BAV resuspension in type A dissection patients showed good short- and mid-term results. It is doable with acceptable results, and full root replacement is not always necessary.