Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve

Wang, Yongshi; Wu, Boting; Li, Jun; Dong, Lili; Wang, Chunsheng; Shu, Xianhong

doi:10.1016/j.athoracsur.2015.10.047

Cited by 50 publications

(38 citation statements)

References 33 publications

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“…30 Maybe our technique of AOP was not perfect or the remaining wall tissue is less resilient in certain patients, especially in those with aortic insufficiency. 31 Because of the reoperations performed and those probably to come in the follow-up time, careful surveillance of patients undergoing AOP is necessary and the indication for AOP needs more restriction or should abandoned at all because AAR showed best results and carried minimal increased surgical risk. Nevertheless, the argument of preserving the Windkessel function with AOP may turn out later in life to be beneficial for left ventricular function.…”

Section: Discussionmentioning

confidence: 99%

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

Sievers¹,

Stock²,

Stierle³

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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In our study, ascending aorta intervention could be performed with low hospital mortality and obviously did not add to the overall mortality compared with no intervention. Ascending aorta replacement was the most definite intervention. The multifactorial decision for ascending aorta intervention including the z score of the ascending aorta was more liberal in younger patients compared to the simple aortic size guidelines and provided excellent results. However, generalizability needs further data.

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Section: Discussionmentioning

confidence: 99%

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

Sievers¹,

Stock²,

Stierle³

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Previous studies have validated the significant differences in systolic aortic flow and WSS patterns between R-L and right-noncoronary (R-N) BAV patients. 10, 11 Since those with moderate-to-severe aortic insufficiency accounted for less than 10% in R-N BAV patients, 16, 26, 27 we chose R-L BAV patients as the study population for further categorization based on valve function. We found it similar to previous reports that R-L BAV patients tended to exhibit peak WSS at the right-anterior or anterior position of ascending aorta, which progressed along a right-handed helical aortic outflow until the level of supra-aortic artery.…”

Section: Discussionmentioning

confidence: 99%

“…10–13 It has been demonstrated in recent cohort studies that BAV patients with aortic insufficiency tended to suffer from a higher risk for progressive ascending aorta dilatation and adverse aortic events after isolated aortic valve replacement surgery compared to their aortic stenosis counterparts. 14–16 However, there is limited data on systolic aortic outflow and WSS distribution as a function of aortic valve dysfunction such as stenosis or insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency

Shan

Wang

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objectives Bicuspid aortic valve (BAV), characterized by valve malformation and risk for aortopathy, displays profound alteration in systolic aortic outflow and wall shear stress (WSS) distribution. The present study performed 4-dimenstional flow MRI in BAV patients with right-left (R-L) cusp fusion, focusing on the impact of valve function upon hemodynamic status within ascending aorta. Methods Four-dimensional flow MRI was performed in 50 R-L BAV subjects and 15 age- and aortic size-matched controls with tricuspid aortic valve. BAV patients were categorized into 3 groups according to their aortic valve function as follows: BAV with no more than mild aortic valve dysfunction (BAV-CTL, n=20), BAV with severe aortic insufficiency (BAV-AI, n=15), and BAV with severe aortic stenosis (BAV-AS, n=15). Results All R-L BAV patients exhibited peak WSS at the right-anterior position of the ascending aorta (BAV vs. TAV at right-anterior position: 0.91±0.23 N/m2 vs. 0.43±0.12 N/m2, p<0.001) with no distinct alteration between BAV-AI and BAV-AS. The predominance of dilatation involving the tubular ascending aorta (82%, type 2 aortopathy) persisted, with or without valve dysfunction. Compared to BAV-CTL subjects, the BAV-AI group displayed universally elevated WSS (0.75±0.12 N/m2 vs. 0.57±0.09 N/m2, p<0.01) in the ascending aorta, which was associated with elevated cardiac stroke volume (p<0.05). The BAV-AS group showed elevated flow eccentricity in the form of significantly increased standard deviation of circumferential WSS, which correlated with markedly increased peak aortic valve velocity (p<0.01). Conclusions The location of peak aortic WSS and type of aortopathy remained homogeneous among R-L BAV patients irrespective of valve dysfunction. Severe aortic insufficiency or stenosis resulted in further elevated aortic WSS and exaggerated flow eccentricity.

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“…Girdauskas et al found that patients with BAV-AI had a 10-fold higher risk of post-AVR aortic dissection when compared to patients with BAV-AS (Girdauskas et al, 2015b). A study by Wang et al (2016) found that patients with BAV-AI had a higher prevalence of R-L fusion phenotypes and wider aortic roots than patients with BAV-AS. Girdauskas et al (2015a) found that 34% of participants with BAV and root phenotype suffered aortic complications after AVR and only 50% of patients in the study were unburdened by aortic complications 15 years post-AVR.…”

Section: Resultsmentioning

confidence: 99%

“…Girdauskas et al reported that 3/56 patients with root phenotype expired due to type A dissection, while 0/153 patients with stenosis and ascending aortic dilation suffered a Type A aortic dissection (Girdauskas et al, 2012, 2015a). Both Girdauskas et al (2012) and Wang et al (2016) found that patients with BAV-AI and root aneurysm are closer to Marfan syndrome (MFS) pathology and have a higher risk of aortic dissection and rupture. When comparing patients with BAV and MFS, Itagaki et al (2015) found that the risk of aortic complications after AVR was 10-times higher for patients with MFS than for patients with BAV, but patients with BAV were at a significantly greater risk than patients with acquired disease of a tricuspid aortic valve.…”

Section: Resultsmentioning

confidence: 99%

Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement

Norton

Yang

2017

Front. Physiol.

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Bicuspid aortic valve (BAV) can be both sporadic and hereditary, is phenotypically variable, and genetically heterogeneous. The clinical presentation of BAV is diverse and commonly associated with a high prevalence of valvular dysfunction producing altered hemodynamics and aortic abnormalities (e.g., aneurysm and dissection). The thoracic aortic aneurysm (TAA) in BAV frequently involves the proximal aorta, including the aortic root, ascending aorta, and aortic arch, but spares the aorta distal to the aortic arch. While the ascending aortic aneurysm might be affected by both aortopathy and hemodynamics, the aortic root aneurysm is considered to be more of a consequence of aortopathy rather than hemodynamics, especially in younger patients. The management of aortic aneurysm in BAV has been very controversial because the molecular mechanism is unknown. Increasing evidence points toward the BAV root phenotype [aortic root dilation with aortic insufficiency (AI)] as having a higher risk of catastrophic aortic complications. We propose more aggressive surgical approaches toward the BAV with root phenotype.

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Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve

Abstract: An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy.

Cited by 50 publications

References 33 publications

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency

Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement

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