Abstract 16909: Acute Type A Aortic Dissection in Patients with Bicuspid Aortic Valve: They Dissect at a Younger Age and with a Distinctive Pattern
Introduction Patients with bicuspid aortic valves (BAV) are at higher risk for aorta-related death (dissection/rupture) than their tricuspid peers (TAV). Whether BAVs dissect in a distinctive pattern and at a younger age is yet unclear.
Methods Between 03/1995 and 06/2011, 369 consecutive patients (92% TAV [N=339] and 8% BAV [N=30]) with acute type-A aortic dissection (AAD) who underwent emergency repair were examined. Upon admission 37% presented with an ectatic/aneurysmal root/ascending aorta (N=135; 46% of BAV [N=14] vs.35% of TAVs [N=121]).
Results BAVs presenting to our emergency room were significantly younger than their tricuspid peers (49.2±13 vs.62.6±13yrs; p<.001) and tended to be more often male (73% [N=22] vs.62% [N=210], p=0.2). An entry tear was identified in 92% of all patients and was located in the root/ascending aorta in 67% (N=248) and in the arch in 25% (N=92). In BAVs, the entry tear was located in the root/ascending aorta in 86% (N=26) vs. 65% (N=221) in TAVs (p<0.001). Atherosclerosis was frequently associated with dissection in TAVs(45%) vs. only 13% of BAVs (p=0.01). Permanent stroke occurred in 4%, and only among TAVs. Surgical repair warranted supracommissural ascending replacement in 57% (23% of BAV [N=7]; 60% of TAV [N=203]) +/- valve replacement in 7%(71% of BAV [N=5]; 26% of TAV [N=52]), root replacement in 35% (80% of BAV(N=24); 31% of TAV [N=106], p<0.001) and root repair in 8% (0.3% of BAV [N=1];8% of TAV [N=28]. Overall hospital mortality was 21.9% (N=81): 23% (N=7) among BAVs vs. 21.5% (N=73) among TAVs. Longevity after 30 days was 1%/patient-year for BAVs and 6.8%/patient-year in TAVs (p=0.008).
Conclusion BAVs dissected at a significantly younger age than their tricuspid peers. The entry tear was located in the aortic root/ascending more often in BAVs mandating complex root surgery, however, long-term survival for BAVs was significantly better than for TAVs compared to each matched normal population.
- © 2012 by American Heart Association, Inc.