AUTHOR=Chen Mi , Xu Wangli , Ding Yan , Zhao Honglei , Wang Pei , Yang Bo , Qiao Huanyu , Zhang Wei , Zhou Chenyang , Jia Junnan , Bai Tao , Xue Jinrong , Zhu Junming , Liu Yongmin , Li Weimin , Sun Lizhong 

TITLE=Integrated Aortic-Valve-And-Ascending-Aortic Replacement vs. Partial Replacement in Bicuspid Aortic Valve-Related Aortopathy

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.771346

DOI=10.3389/fcvm.2021.771346

ISSN=2297-055X

ABSTRACT=<p><bold>Objective:</bold> We sought to evaluate the outcomes of integrated aortic-valve and ascending-aortic replacement (IR) vs. partial replacement (PR) in patients with bicuspid aortic valve (BAV)-related aortopathy.</p><p><bold>Methods:</bold> We compared long-term mortality, reoperation incidence, and the cumulative incidence of stroke, bleeding, significant native valve or prosthetic valve dysfunction, and the New York Heart Association (NYHA) functional classes II-IV between inverse probability-weighted cohorts of patients who underwent IR or PR for BAV-related aortopathy in a single center from 2002 to 2019. Patients were stratified into different aortic diameter groups (“valve type” vs. “aorta type”).</p><p><bold>Results:</bold> Among patients with “valve type,” aortic valve replacement in patients with an aortic diameter &gt; 40 mm was associated with significantly higher 10-year mortality than IR compared with diameter 35–40 mm [17.49 vs. 5.28% at 10 years; hazard ratio (HR), 3.22; 95% CI, 1.52 to 6.85; <italic>p</italic> = 0.002]. Among patients with “aorta type,” ascending aortic replacement in patients with an aortic diameter 52–60 mm was associated with significantly higher 10-year mortality than IR compared with diameter 45–52 mm (14.49 vs. 1.85% at 10 years; HR, 0.04; 95% CI, 1.06 to 85.24; <italic>p</italic> = 0.03).</p><p><bold>Conclusion:</bold> The long-term mortality and reoperation benefit that were associated with IR, as compared with PR, minimizing to 40 mm of the aortic diameter among patients with “valve type” and minimizing to 52 mm of the aortic diameter among patients with “aorta type.”</p><p><bold>Trial Registration:</bold> Treatment to Bicuspid Aortic Valve Related Aortopathy (BAVAo Registry): ChiCTR.org.cn no: ChiCTR2000039867.</p>