18. SHOULD A SEPARATE VALVE AND GRAFT BE USED FOR REPAIR OF BICUSPID AORTIC VALVE AND ASCENDING AORTIC ANEURYSM?
Thoralf M. Sundt, Bassem N. Mora, Marc R. Moon, Marci S. Bailey, Michael K. Pasque, and William A. Gay
Washington University School of Medicine
Saint Louis, Missouri, USA
BACKGROUND
Ascending aortic aneurysms (AscAA) associated with bicuspid aortic valve (BAV) are thought to be due to an inherent abnormality of the aortic wall. Repair using separate valve and supracoronary graft (V+G) rather than composite valve-graft (CVG) is straightforward, but leaves potentially abnormal sinus tissue behind.
MATERIAL AND METHODS
Between January 1985 and January 1998, 45 patients with BAV and AscAA underwent either CVG (n=18) or V+G (n=27). Early and late outcomes were compared. Follow-up was 100% complete (mean 5.6 years, range 1 month 13 years).
RESULTS
Demographics were similar except for age (mean 42.4
± 12.1 years CVG vs 60.0± 13.0 years V+G, P=0.03). Concomitant coronary artery bypass was more common in the V+G group (1/18 vs 15/27, P=0.001). There were two perioperative deaths after V+G (7.4%), but none after CVG (P=0.98). No differences in perioperative morbidity were identified. Actuarial survival differed at 5 years (V+G=79% vs CVG=94%, P=0.03). Multivariable analysis identified age (P=0.02), but not surgical procedure (P=0.91), as a risk factor for early or late death. There were no reoperations or late deaths related to proximal aneurysm formation.CONCLUSION
Separate V+G continues to have a place in the setting of BAV with AscAA, particularly in older patients and those requiring concomitant procedures.
