Comparison of reduction ascending aortoplasty and ascending aortic replacement for bicuspid valve related aortopathy in young adult patients undergoing aortic valve replacement--long-term follow-up.

BACKGROUND: We aimed to determine the long-term outcomes of reduction ascending aortoplasty and ascending aortic replacement. A secondary aim was to document our experience with the long-term "growth" of woven Dacron grafts.

METHODS: Over a nine-year period (1992-2001), 154 patients underwent aortic valve replacement using the Ross procedure for bicuspid aortic valve disease (BAV). Twenty-five also underwent reduction ascending aortoplasty (RAA), and 16 underwent ascending aorta replacement (AAR), using a Dacron graft. Preoperative diameters were measured prospectively. Patients had a follow-up CT chest between January and December 2007 to measure the mid-ascending aortic diameter.

RESULTS: Mean age at operation was 31.8+/-13.5 years (RAA), and 40.0+/-8.6 years (AAR) (p=NS). Mean follow-up was 101 months (+/-43.0, 95% CI) in the RAA group, and 107 months (+/-29.0, 95% CI) in the AAR group. Mean pre-operative diameter in the RAA group was 41.5mm (+/-11.8, 95% CI) and in the AAR group 46.2mm (+/-7.8, 95% CI) (p=0.004). Mean follow-up diameter in the RAA group was 35.4mm (+/-4.6, 95% CI) and in the AAR group 31.9 mm (+/-6.8, 95% CI) (p=0.003). Growth of the woven Dacron prosthesis was 23.4% (+/-26.8, 95% CI) in the 107-month follow-up period. There was no early or late mortality and no further aortic surgery during follow-up.

CONCLUSIONS: We have demonstrated satisfactory long-term outcomes with both RAA and AAR in patients with BAV related aortopathy who have undergone the Ross procedure. We have noted a greater diameter reduction with AAR when compared with RAA over nine years. In this series, "growth" of the woven Dacron grafts occurred, however individual measures did not correlate with other studies.