Dilatación de arco aórtico en la aortopatía asociada a válvula aórtica bicúspide: factores predictivos y seguimiento a medio plazo

Abstract

IntroductionAortic arch dilation, as well as the need to perform arch surgery on the bicuspid aortic valve, is controversial. In this study, an analysis is performed on the predictive factors of arch dilation in bicuspid aortic valve, and the rate of dilation in the arch preserved after surgery. MethodsAn analysis was performed on 161 patients with bicuspid aortic valve aneurysms and elective surgery. Arch dilation was considered if diameter ≧40mm and/or index ≧2.1cm/m2 (angioCT). The relationship between the valvular lesion and phenotype and other factors was analysed, as well a study of the annual dilation and re-operation rate in patients with preserved arch. ResultsThe large majority (83.2%) were male, and the mean age was 57.1±13 years. Arch diameter and index were 35.6±5.8mm and 1.9±0.4cm/m2, respectively, with 12.4% of patients having a bovine arch. Arch dilation was observed in 27.3% (diameter) and 32.3% (index). Age, right-non coronary type and lateral bicuspid valve opening were predictors of dilation. In-hospital death was 2.5% (EuroSCORE-II: 4.4%). On follow-up (mean 32 months) arch dilation rate was 0.3±0.6mm/year, with age as the only predictor. Further aortic surgery was required in 1.3%, but none of them for arch reasons. ConclusionsLess than 33% of bicuspid aortic valve aneurysms have arch involvement. Dilation after surgery occurs slowly, and the need for re-operation is rare. Therefore, systematic arch replacement is not justified.