Fate of Normally Functioning Bicuspid Aortic Valve in Patients Undergoing Ascending Aorta Surgery

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV), though normally functioning, is frequently associated with dilatation of the aortic root and ascending aorta. Optimal surgical treatment remains controversial. The study aim was to evaluate the fate of the normally functioning spared BAV at long-term follow up.METHODS: Forty patients (26 males, 14 females; mean age 59 +/- 11 years; range: 38-81 years) who underwent aortic surgery for proximal aortic disease between 1996 and 2011, with spared BAV at surgery, were included in the study. The main indication for surgery was ascending aorta aneurysm. Of the patients, 37 had ascending aorta replacement and three underwent a semi-Yacoub procedure. Adjunctive subcommissural annuloplasty was performed in 12 cases. The clinical and echocardiographic follow up (median 62 months; range: 7-175 months) was 100% complete.RESULTS: In-hospital survival was 100%. Pre-discharge echocardiography showed no cases of significant aortic regurgitation (grade > or = 3+) or stenosis. The probability of survival at five and 10 years was 93 +/- 7% and 79 +/- 10%, respectively. Two surviving patients (5%) required reoperation for the development of aortic insufficiency. Freedom from aortic valve replacement was 100% and 90 +/- 10% at five and 10 years, respectively, and freedom from thromboembolic or bleeding events was 100% and 90 +/- 10% at five and 10 years, respectively. No cases of endocarditis were reported. The composite event-free survival at five and eight years was 85 +/- 6% and 69 +/- 11%, respectively. There were no cases of root enlargement during the follow up period.CONCLUSION: A spared BAV offers a good time-span of functional integrity. The conservative approach seems to be a valid strategy, with a low risk of reintervention and cardiovascular events during long term follow up, in selected patients.