Predictors of ascending aortic dilation in bicuspid aortic valve disease: a five-year prospective study
Student AuthorsWilliam Martin-Doyle
Document TypeJournal Article
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AbstractBackground: Bicuspid aortic valves are associated with aortic dilation and dissection. There is a paucity of prospective studies evaluating changes in aortic size over time in adult subjects with bicuspid aortic valves. Methods: A total of 115 subjects with asymptomatic bicuspid aortic valves were enrolled from 2003 to 2008 and followed prospectively over 5 years. Clinical and family histories, as well as transthoracic echocardiograms, were obtained at baseline, and echocardiograms were performed annually thereafter. Results: The mean age of subjects was 41.8 ± 12.8 years, and 61% were male. Ascending aortic size at baseline averaged 35.5 ± 5.6 mm and increased in 71.1% of subjects (mean, 0.66 ± 0.05 mm/y; range, 0.2-2.3 mm/y) over an average of 4.8 years. In 15.6% of subjects, the rate of change exceeded 1 mm/y. The average rate of ascending aortic dilation for all subjects was 0.47 ± 0.05 mm/y (P < .001). A family history of aortic valve disease was associated with progression in both unadjusted (P = .029) and logistic regression analyses adjusted for age, gender, and body surface area (odds ratio, 13.7; P = .021). Multivariate analysis did not find leaflet orientation or moderate to severe aortic valve dysfunction as independent predictors of aortic dilation. Conclusions: We found that in subjects with bicuspid aortic valve, studied prospectively, there was an annual rate of ascending aortic dilation of 0.47 mm/y. In contrast to previous reports, leaflet orientation and aortic valve dysfunction were not independent predictors of aortic dilation. A family history of aortic valve disease was associated with a significantly increased risk of increasing ascending aortic size.
SourceAvadhani SA, Martin-Doyle W, Shaikh AY, Pape LA. Predictors of ascending aortic dilation in bicuspid aortic valve disease: a five-year prospective study. Am J Med. 2015 Jun;128(6):647-52. doi: 10.1016/j.amjmed.2014.12.027. Epub 2015 Jan 30. PMID: 25644322.
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/52035
RightsCopyright © 2015 Elsevier Inc. All rights reserved.
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Frequency of Ascending Aorta Replacement: A Description of 105 Patients with Bicuspid Aortic Valve Undergoing Aortic Valve ReplacementMitchell, Elizabeth C. (2006-06-01)Background: It has been well documented that patients with a congenital bicuspid aortic valve suffer from earlier valve dysfunction and abnormalities of the ascending aorta, frequently requiring aortic valve replacement and some requiring replacement of the ascending aorta. There have been a few reports with variable data on the frequency of aortic complications, including dilation, aneurysm and dissection, at the time of surgery. Whether or not to replace the ascending aorta at the time of AVR is certainly influenced by the presence of these aortic complications but there is no clear evidence to suggest at a definitive marker. With more evidence that increasing aortic size leads to increased rate of rupture and dissection, in addition to recent evidence that suggests that ascending aorta dilation continues after AVR, it is questionable whether or not this has affected the rate of ascending aorta replacement at the time of AVR. Objectives: (1) To assess the frequency of aortic abnormalities in bicuspid aortic valve patients at the time of aortic valve replacement, (2) identify the predictors for ascending aortic complications and ascending aortic replacement in bicuspid aortic valve patients undergoing aortic valve replacement and (3) describe the clinical and echocardiographic characteristics of patients with bicuspid aortic valve requiring aortic valve replacement. Methods: With permission from the IRB, we retrospectively searched all echocardiographic and transcription reports from 1995-2002 for patients with a bicuspid aortic valve. Of these patients, we identified 105 patients that had undergone an aortic valve replacement and had sufficient echocardiographic evidence of a BAV. Trans-esophageal and trans-thoracic echocardiograms were reviewed, data was gathered on the dimensions of the ascending aorta and valve function. Medical records were reviewed for information on the patients’ past medical history, operative reports were reviewed to verify intra-operative assessment of aortic valve morphology. Results: The majority of our patient population was male, 83.8%. The average age at the time of surgery was 53.2. Of the 105 patients in our study, 28 (27.2%) had the ascending aorta replaced in addition to the aortic valve replacement. Aortic dilation was considered to be 4.2 cm or greater for males and 3.6 cm or greater for females; 36.3% of the total population had aortic dilation, 33.7% of males and 50% of females. In terms of valve function, 48.5% of the population had aortic stenosis; of the males 45.3% had aortic stenosis and of the females 64.7% had aortic stenosis. Aortic insufficiency was present in 34 % of the population, 37.2% of the males and 17.6% of the females. 12.6 % of the population had both aortic stenosis and aortic insufficiency and 6% had normal functioning aortic valves. Conclusion: Compared to previously reported ascending aorta replacement rates of 17%, the rate of replacement at our institution was higher at 27.2%. The rates of ascending aorta dilation and valve function abnormalities were very similar to previously reported frequencies. With evidence to suggest that rates of aortic rupture and dissection are greater than previously expected in patients with dilated ascending aortas, we would expect to see an even greater increase in the replacement of the ascending aorta with AVR. In addition, studies that suggest aortic dilation continues after AVR may also influence an increase in this frequency as well.
Evolution of fenestrated/branched endovascular aortic aneurysm repair complexity and outcomes at an organized center for the treatment of complex aortic diseaseSimons, Jessica P; Crawford, Allison S; Flanagan, Colleen P; Aiello, Francesco A; Arous, Edward J; Judelson, Dejah R; Messina, Louis M; Robichaud, Devon I; Valliere, Shauneen A; Schanzer, Andres (2021-04-01)Background: Fenestrated/branched endovascular aneurysm repair (F/BEVAR) volume has increased rapidly, with favorable outcomes at centers of excellence. We evaluated changes over time in F/BEVAR complexity and associated outcomes at a single-center complex aortic disease program. Methods: Prospectively collected data of all F/BEVAR (definition: requiring ≥1 fenestration/branch), procedures performed in an institutional review board-approved registry and/or physician-sponsored investigational device exemption trial (IDE# G130210), were reviewed (11/2010-2/2019). Patients were stratified by surgery date into thirds: early experience, mid experience, and recent experience. Patient and operative characteristics, aneurysm morphology, device types, perioperative and midterm outcomes (survival, freedom from type I or III endoleak, target artery patency, freedom from reintervention), were compared across groups. Results: For 252 consecutive F/BEVARs (early experience, n = 84, mid experience, n = 84, recent experience, n = 84), 194 (77%) company-manufactured custom-made devices, 11 (4.4%) company-manufactured off-the-shelf devices, and 47 (19%) physician-modified devices, were used to treat 5 (2.0%) common iliac, 97 (39%) juxtarenal, 31 (12%) pararenal, 116 (46%) thoracoabdominal, and 2 (0.8%) arch aneurysms. All patients had follow-up for 30-day events. The mean follow-up time for the entire cohort was 589 days (interquartile range, 149-813 days). On 1-year Kaplan-Meier analysis, survival was 88%, freedom from type I or III endoleak was 91%, and target vessel patency was 92%. When stratified by time period, significant differences included aneurysm extent (thoracoabdominal, 33% early experience, 40% mid experience, and 64% recent experience; P < .001) and target vessels per case (four-vessel case, 31% early experience, 39% mid experience, and 67% recent experience; P < .0001). There was no difference, but a trend toward improvement, in composite 30-day events (early experience, 39%; mid experience, 23%; recent experience, 27%; P = .05). On Kaplan-Meier analysis, there was no difference in survival (P = .19) or target artery patency (P = .6). There were differences in freedom from reintervention (P < .01) and from type I or III endoleak (P = .02), with more reinterventions in the early experience, and more endoleaks in the recent period. Conclusions: Despite increasing repair complexity, there has been no significant change in perioperative complications, overall survival, or target artery patency, with favorable outcomes overall. Type I or III endoleaks remain a significant limitation, with increased incidence as the number of branch arteries incorporated into the repairs has increased.
C'est LAVi: What Left Atrial Dilatation Tells Us About Diastolic Function in Aortic StenosisTighe, Dennis A.; Aurigemma, Gerard P. (2016-10-10)Calcific degenerative aortic valve stenosis (AS) is the most common acquired form of heart valve disease that afflicts the elderly population1 and usually comes to attention when an echocardiogram is ordered to evaluate a systolic murmur in an older subject. As is evident to anyone practicing cardiology these days, the advent of transcatheter aortic valve replacement has focused much attention on the evaluation and optimal treatment of patients with AS. AS often has a long latency period in which symptoms are absent, and, importantly, sudden unexpected cardiac death is rare.2,3 With symptom onset, survival is markedly reduced without intervention.4–6 For symptomatic patients with severe AS and normal flow-high gradient characteristics and normal left ventricular ejection fraction (LVEF) (stage D1), aortic valve replacement (AVR) is a class 1 indication. Similarly, for asymptomatic patients with severe AS and LVEF less than fifty percent not because of another cause (stage C2), AVR also is indicated.