Progressive aortic dilation after aortic valve replacement

Abstract

AimAscending aortic dilation is not an uncommon complication following aortic valve replacement (AVR). However, the clinical features of ascending aortic dilation after AVR are rarely described. The etiologies responsible for the development of progressive aortic dilation in such patients are not fully understood.Patients and MethodsFrom January 2006 to November 2008, 10 consecutive patients requiring ascending aortic replacement after initial AVR were enrolled into this study cohort.ResultsThe etiologies of the aortic valves subjected to the initial AVR were congenitally bicuspid (aortic valve regurgitant) in two (20 per cent), rheumatic aortic stenosis in three (30 per cent) and rheumatic combined stenotic and regurgitant aortic valve in five (50 per cent) patients, respectively. The surgical indications for subsequent aorta replacement were ascending aortic dilation in eight (80 per cent), aortic dissection in one (10 per cent), and aortic dilation and dissection in one (10 per cent) patient, respectively. The interval between initial AVR and aorta replacement was 8–32 (mean: 17.1 ± 9.1) years. The dimensions of the aortic root and ascending aorta late after AVR were 4.64 ± 1.20 cm and 5.06 ± 0.69 cm, respectively. There were no significant differences in the extent of expansion of the aortic root and the ascending aorta (0.8810 ± 0.7475 cm vs 1.0800 ± 0.6202 cm, P = 0.5252). The mean expansion rates of the aortic root and the ascending aorta were 0.052 cm/year and 0.063 cm/year between initial AVR and subsequent aorta replacement, respectively. The dimensions of the aortic root and ascending aorta measured at the initial operations and the aorta replacement did not seem to have any differences between patients with a native bicuspid aortic valve and those with a tricuspid aortic valve. No significant correlation was found between the dimension of the aortic root or ascending aorta and the independent variables.ConclusionAortic dilation might develop in younger patients late after AVR with time. Aortic dilation might involve the aortic root and ascending aorta. Neither a significant difference nor a consistent correlation was noted between expansion dimensions of aortic root and ascending aorta dilation. In patients, AVR cannot effectively hold back aortic dilation, and the mean expansion rates of the aortic root and of the ascending aorta are above 0.05‐0.06 cm/year after AVR. Early surgical intervention is necessary in order to prevent aortic rupture or dissection, and long‐term follow up is warranted in such patients.