Mid-term Prognosis Of Reduction Ascending Aortoplasty (RAA) For Dilatation Of The Ascending Aorta In Patients With Aortic Valve Disease

Objective The aim of this study was to identify the mid-term prognosis of reduction ascending aortoplasty (RAA) for dilatation of the ascending aorta in patients with aortic valve disease.Methods From January 2010 to December 2013,102 patients with aortic valve disease and ascending aortic dilatation who had undergone aortic valve replacement (AVR) combined with RAA in our institution were enrolled. Patients with bicuspid aortic valve (BAV) (n=57) and patients without BAV (NBAV) (n=45) were analyzed. Patients’mean age was 52.7±12.9 years,71.6% was male, New York Heart Association (NYHA) class III or IV was 43.7%, preoperative left ventricular end-diastolic diameter (LVEDD) was 56.9±9.1 mm, ejection fraction (EF) was 61.3%±8.9%, diameter of aortic sinuses was 35.9±5.3 mm, diameter of ascending aorta was 45.6±4.9 mm. The study endpoints were postoperative death, reoperation, stroke and aorta-related complications (dissection or rupture).Results Follow-up data were obtained in all patients. Mean follow-up was 38.8±13.0 months. BAV group was younger than NBAV group (p=0.004). More patients with mitral valve diseases (p<0.01) and tricuspid insufficiency (p<0.01) were found in NBAV group. The left atrium in BAV group was smaller than NBAV group (p=0.004). More patients with ascending aorta of greater than 45mm were present in BAV group (p=0.004). Two patients had died and 1 patient had stroke. There were no reoperations and aorta-related complications. When compared with preoperative data, postoperative LVEDD, diameter of left atrium, diameter of aortic sinuses, diameter of ascending aorta had decreased significantly (p<0.001). The mean expansion degree of ascending aorta was 0.39±0.26cm and the mean ascending aorta expansion rate was 1.3±0.8 mm/y in patients with aortic redilation. Redilation of the ascending aorta was found in BAV group (37.0±5.0 mm vs. 35.5±4.6 mm, p=0.009) while NBAV group had no significant change (36.1±4.7 mm vs. 35.5±4.6mm,p=0.188).Conclusions Reduction ascending aortoplasty showed good mid-term results in patients with aortic valve disease and dilatation of the ascending aorta. Redilation tended to happen in patients with BAV and long-term follow-up was necessary.