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Aortic Expansion Rate in Patients With Dilated Post-Stenotic Ascending Aorta Submitted Only to Aortic Valve Replacement: Long-Term Follow-Up
Study Questions:
What is the evolution of aortic dimensions in patients with moderate post-stenotic ascending aorta dilation (50-59 mm) submitted to aortic valve replacement (AVR) alone?
Methods:
Ninety-three patients affected by severe isolated calcific aortic valve stenosis in the tricuspid aortic valve accompanied by moderate dilation of the ascending aorta (50-59 mm) were submitted to AVR only. All patients were followed for a mean of 14.7 ± 4.8 years by means of periodic clinical evaluations and echocardiography and tomography scans of the thorax.
Results:
Operative mortality was 1.0% (one patient). During the follow-up, 16 patients died and two had to be reoperated for valve dysfunction. No patients experienced acute aortic events (rupture, dissection, pseudoaneurysm), and no patient had to be reoperated on the aorta. There was not a substantial increase in aortic dimensions: mean aortic diameter was 57 ± 11 mm at the end of the follow-up versus 56 ± 02 mm preoperatively (p = NS). The mean ascending aorta expansion rate was 0.3 ± 0.2 mm/yr.
Conclusions:
The authors concluded that in the absence of connective tissue disorders, AVR alone is sufficient to prevent further aortic expansion in patients with moderate post-stenotic dilation of the ascending aorta.
Perspective:
This case series suggests that when aortic dilation is the consequence of the modified flow patterns through the stenotic valve and the vascular wall histology is normal, valve replacement alone can interrupt the process and prevent further aortic dilatation. Based on this, it seems reasonable to suggest that ascending aorta replacement be considered only for very young patients with extremely long life expectancy. Since these data contradict published guidelines, further larger studies are needed to validate these findings and develop disease-specific therapeutic guidelines for the different types of ascending aorta aneurysms.
Keywords: Aneurysm, False, Follow-Up Studies, Tomography, Dilatation, Echocardiography
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