David N. Ranney1, Ehsan Benrashid1, Babatunde A. Yerokun1, Jatin Anand1, Hanghang Wang1, J. Kevin Harrison2, Andrew Wang2, Todd L. Kiefer2, G. Chad Hughes1,31Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, USA
2Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, USA
3Electronic correspondence: firstname.lastname@example.org
Background and aim of the study: In regard to bicuspid aortic valve (BAV) aortopathy, 2016 ACC/AHA guideline clarifications suggest replacement at >4.5 cm in patients with a primary valve indication for surgery, and at ≥5.0 cm for asymptomatic patients without a valve indication at low surgical risk (<4%) at experienced centers (Class IIa). The study aim was to report outcomes of proximal aortic replacement in low-risk BAV patients in accordance with these guidelines.
Methods: Among a total of 979 patients who underwent proximal aortic repair between January 2005 and September 2016 at a single referral aortic center, 389 (39.7%) had BAV aortopathy. Of these latter patients, 336 were considered low risk as defined by age <75 years and elective procedure status. Primary outcomes included 30-day/in-hospital results, long-term survival, and freedom from reoperation.Results: The mean patient age was 53.4 ± 12.3 years, and 80% were males.
The mean aortic diameter at the time of operation was 5.3 ± 0.6 cm. The incidences of 30-day/in-hospital death, stroke and new dialysis-dependent renal failure were 0%, 0.3%, and 0%, respectively. At a mean follow up of 41 months, reoperation was required in three patients (0.9%). The Kaplan-Meier estimate of overall survival at 10 years was 90.8%.
Conclusion: Elective repair of BAV aortopathy can be achieved with excellent early and long-term outcomes at referral aortic centers. These data suggest that recently clarified ACC/AHA guidelines are appropriate, although lowering the definition of low risk from 4% to <1% predicted mortality should be considered, as defined in the 2014 Canadian Cardiovascular Society Guidelines.
This study was presented in part at the 66th Annual Scientific Session of the American College of Cardiology, Washington, DC, March 17-19, 2017
The Journal of Heart Valve Disease 2018-19;27:244-250
|Surgery for Patients with Bicuspid Aortopathy: Validation of the 2016 ACC/AHA Guidelines Clarification|
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