Abstract 2960: Ascending Aorta Complications in Bicuspid Aortic Valve With or Without Coarctation Of The Aorta. A Long-term Follow-up Study
Background: Recent studies have shown high incidence of ascending aorta complications (AAC) in patients with coarctation of the aorta (CA) and coexistent bicuspid aortic valve (BAV). However, whether CA is an independent risk factor for AAC has not been well defined yet.
Methods: From 1989 to 2007, 652 patients with a BAV were included in our data base. An AAC complication was diagnosed when one of the following criteria were present: aortic dilatation of a diameter > 55 mm (aneurysm); type I-II aortic dissection; acute rupture resulting in sudden death, or rupture of a sinus of Valsalva aneurysm (fistula). Incidence of AAC was analyzed in patients without AAC at the initial study who were followed for a period superior to one year without surgical intervention of the ascending aorta. Patients were classified as having or not coexisting CA. Kaplan-Maier cumulative survival without event were performed.
Results: 312 patients with BAV (mean age 41 ± 18 years; 69% male) were followed-up for a mean period of 9.5 ± 6 years (total 2,977 patient-years). A coexisting CA was present in 83 cases. Incidence of AAC during follow up was 4.5% (14 cases). There was 9 AAC in 83 patients with CA (11% or 1.0 per 100 patient-years): aneurysm (6); dissection (1); rupture (1); fistula (1). However, there was only 5 AAC out 245 patients without CA: aneurysm in all cases (2.2% or 0.2 per 100 patient-years; p<0.01). Despite that patients with isolated BAV were older (p<0.001) and had greater aortic root dimension (p<0.05), peak systolic pressure gradient (p<0.01) and aortic regurgitation degree (p<0.001) at initial study than patients with BAV+CA, cumulative survival without event at 20 years of follow up was 77% in patients with CA and 89% in patients without CA (p<0.01)
Conclusions: Our results highlight the adverse impact of the association of CA and BAV on the incidence of AAC at follow-up. In spite of more severe valvular dysfunction, larger aortic root dimension and older age a very low incidence of AAC in isolated BAV was observed.