Fate of mild-to-moderate bicuspid aortic valve disease untreated during
ascending aorta replacement
Background: Bicuspid aortic valve (BAV) is the most common congenital
heart defect and it is responsible for an increased risk of developing
aortic valve and ascending aorta complications. In case of mild to
moderate BAV disease in patients undergoing supracoronary ascending
aorta replacement, it is unclear whether a concomitant aortic valve
replacement should be performed. Methods: From June 2002 to January
2020, 75 patients with mild-to-moderate BAV regurgitation (±
mild-to-moderate stenosis) who underwent isolated supracoronary
ascending aorta replacement were retrospectively analyze. Clinical and
echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max
16.4). Kaplan Meier estimates were employed to analyze long-term
survival. Cumulative incidence function for time to re-operation,
recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS)
greater than moderate, with death as competing risk, were computed.
Results: There was no hospital mortality and no cardiac death occurred.
Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63].
At follow-up there were no cases of aortic root surgery whereas 3
patients underwent AV replacement. At 12 years the CIF of reoperation
was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was
present in 1 pt and AS greater than moderate in 3. At 12 years the CIF
of AR>2+/4+ was 5.1±4.98% and of AS>moderate
6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a
BAV did not significantly worse at least up to 10 years after isolated
supracoronary ascending aorta replacement.