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(Circulation. 1999;100:II-287.)
© 1999 American Heart Association, Inc.

Aortic and Peripheral Vascular Surgery

Predictors of Proximal Aortic Dissection at the Time of Aortic Valve Replacement

Yskert von Kodolitsch, MD; Ognjen Simic, MD; Ann Schwartz, PhD, MPH; Christoph Dresler, MD; Roger Loose, MD; Martin Staudt, MD; Jörg Ostermeyer, MD; Axel Haverich, MD; Christoph A. Nienaber, MD

From the Department of Internal Medicine, Division of Cardiology (Y.v.K., C.A.N.), University Hospital Eppendorf, Hamburg; the Department of Cardiovascular Surgery (O.S., M.S., J.O.), St. Georg Hospital, Hamburg; the Department of Cardiovascular Surgery (C.D., A.H.), Hannover Medical School, Hannover; the Department of Cardiovascular Surgery (R.L.), Christian-Albrechts-University, Kiel, Germany; and the Department of Human Genetics (A.S.), MCP-Hahnemann School of Medicine, Pittsburgh, Pa.

Correspondence to Christoph A. Nienaber, MD, Department of Internal Medicine, Division of Cardiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail nienaber{at}uke.uni-hamburg.de

Background—Type I aortic dissection develops in 0.6% of patients late after aortic valve replacement (AVR), and 13% of patients with type I aortic dissections have a history of AVR. Predictors of aortic dissection at AVR, however, have not been characterized.

Methods and Results—A study group of 33 patients with type I aortic dissection had aortic surgery 49±55 months after routine AVR. A group of 101 controls, who did not have morphological progression of aortic diameters 6 years after AVR, was used to identify predictors of postsurgical dissection. Multivariate analysis identified aortic regurgitation (P<0.002) and fragility (P<0.001) or thinning of the aortic wall (P<0.007) at AVR as predictors, associated with a 14%, 22%, and 7% probability of late aortic dissection, respectively. Clamping times, types of valve prostheses, concomitant coronary artery bypass grafting, and mean ascending aortic diameters of 43±10 mm at AVR did not predict late dissection. A separate analysis of 29 nondissecting aneurysms of the ascending aorta developing 104±64 months after routine AVR revealed younger age at AVR (P<0.003) and congenitally bicuspid aortic valves (P<0.03) as predictors of late aneurysm formation.

Conclusions—Aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation may reflect aortic root disease, with a high risk for postsurgical aortic sequelae if it is treated incompletely by isolated valve replacement.

Key Words: aneurysm • aorta • risk factors • surgery • valves