Fate of Un-replaced Sinuses of Valsalva in Bicuspid Aortic Valve Disease: Follow-up to 17 years

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Fate of Un-replaced Sinuses of Valsalva in
Bicuspid Aortic Valve Disease Follow-up to 17
years
Chan Park1, Hector Michelena2, Thoralf M.
Sundt1 Divisions of Cardiovascular Surgery1 and
Cardiovascular Medicine2 Mayo Clinic Rochester,
Minnesota
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Patient Characteristics
Age (yrs) 6213
Male () 75.2
F/U period (yrs) 0-17(3.3)
Diabetes mellitus () 10.1
Hypercholesterolemia () 60.6
Renal failure () 2.3
NYHA III/IV () 39.0
Coronary artery disease () 30.7
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Operative Results
ACC (min) 68.828.9
CPB (min) 96.043.7
Circulatory arrest (min) 18.513.2
Type of Valve (MechBio) 109109
Procedures
NCC procedure 15 (6.9)
Ascending aortoplasty 65 (29.8)
Ascending graft 153 (70.2)
Arch surgery 13 (6.0)
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Preoperative Echo finding
Dominance
Stenosis () 69.6
Insufficiency () 24.9
Mixed () 5.5
EF () 59.511.7
Size (mm)
Annulus 25.74.6
Sinus 40.45.7
STJ 34.65.3
Ascending aorta 50.66.8
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Outcomes

• Operative mortality 2.8
• Overall mortality 28/218 (12.8)
• Cause of death
• Cardiac 5/28 (17.9)
• Non-cardiac 11/28 (39.3)
• Unknown 12/28 (42.9)

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Reoperation

• Reoperation 10/218 (4.6)
• Indication
• Aortic root dilation (1)
• Ascending aorta dilatation (2)
• PVE (3)
• PPM (2)
• Others (4)

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Details for Reoperations
Sex Age Interval (yrs) Primary operation Reason for reoperation Reoperation
M 49 13.2 Aortoplasty PPM AVRCABG
M 71 0.3 AscAoRp PVE AVR
M 67 9.2 Aortoplasty CABG Aortic Root and AscAo dilatation Graft replaceof AoRoot AscAo
M 65 1.5 Aortoplasty RCA aneurysm CABG
M 40 9.0 Aortoplasty PPM AscAo dilatation AVRAscAo replace
M 65 3.8 Aortoplasty PVE Homograft replacement of AoRoot CABG
M 75 0.9 AscAoRp Mediastinitis Valveless Homograft AscAo replacement
M 75 0.3 AscAoRp PVE Homograft replacement of AoRoot
M 60 0.1 TotalArchProxDescCABG Thoracoabdominal aneurysm Thoracoabdominal aorta replacement
M 63 1.3 AscAoRpPFO closure Periprosthetic leakage Repair of periprosthetic leakage
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Survival Freedom from Reoperation
100
80
60
Probability ()
40
1 year probability 97.6 5 year probabilitiy
94.9 10 year probability 85.5
20
0
0
2
4
6
8
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Follow-up (years)
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Univariate Analysis for Overall Survival
HR p value
Age 1.08 0.001
DM 4.99 lt0.001
Preop renal failure 6.86 0.002
NYHA (III/IV) 2.41 0.028
CAD 3.62 lt0.001
Bioprosthetic valve 2.47 0.023
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Multivariate Analysis for Overall Survival
HR p value
Age 1.07 0.001
DM 5.32 lt0.001
Preop renal failure 8.43 0.001
NYHA (III/IV) 2.28 0.044
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Change of Aortic Size at 5 years (n 28)



plt0.05 preop vs postop, plt0.001 preop vs
postop
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Conclusions

• The sinuses of Valsalva rarely dilate
  significantly after AVR and aortic repair
• Separate valve and graft remains a reasonable
  option in the absence of significant root
  dilatation
• The ascending aorta remains at risk of late
  dilatation if treated with aortoplasty