Type A aortic dissection in patients with bicuspid or tricuspid aortic valves: a retrospective comparative study in 288 Chinese patients.

Abstract

OBJECTIVES:

The propensity for aortic aneurysm and dissection bestows bicuspid aortic valves (BAVs), the most common congenital cardiac abnormality, a potentially lethal aspect and considerable clinical concern. In the present study, we attempted to better characterize BAV patients with acute type A aortic dissection (AAD).

METHODS:

Data from 288 consecutive patients undergoing surgery for acute AAD between December 2007 and April 2012 at our institute were retrospectively collected. Patients were categorized into BAV (n = 30) and tricuspid aortic valve (n = 258) groups to investigate their clinical and prognostic features.

RESULTS:

BAV patients tended to have younger age, lower systolic blood pressure, higher rate of moderate-to-severe aortic stenosis and wider ascending aorta (all P < 0.05). The 30-day postoperative mortality was significantly higher among BAV patients (23.3 vs 8.1%, P = 0.016), with an elevated proportion of both cardiogenic deaths and complications. BAV patients who died during the follow-up period demonstrated higher incidence of aortic stenosis (57.1 vs 13.0%, P = 0.033), coronary artery ostium involvement (57.1 vs 4.3%, P = 0.006) and longer cardiopulmonary bypass time (190.7 ± 67.5 vs 140.3 ± 37.1 min, P = 0.035).

CONCLUSIONS:

BAV-associated dissection, as a unique subgroup of AAD, demonstrated strikingly high postoperative mortality in a Chinese population. Moderate-to-severe aortic stenosis and dissection involving coronary artery ostium might be associated with the adverse clinical outcomes among BAV patients.

• Authors: Yongshi Wang, Boting Wu, Lili Dong, Chunsheng Wang, Xianhong Shu
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 44 Issue 1 Pg. 172-7 (Jul 2013) ISSN: 1873-734X [Electronic] Germany
• PMID: 23211351 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aortic Dissection (epidemiology, mortality, surgery)
• Aortic Aneurysm (epidemiology, mortality, surgery)
• Aortic Valve (abnormalities)
• Aortic Valve Stenosis
• Bicuspid Aortic Valve Disease
• China
• Female
• Heart Valve Diseases (epidemiology)
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Postoperative Complications
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Tricuspid Valve (pathology)