Background
—Type I aortic dissection develops in 0.6% of patients late after aortic valve replacement (AVR), and 13% of patients with type I aortic dissections have a history of AVR. Predictors of aortic dissection at AVR, however, have not been characterized.
Methods and Results
—A study group of 33 patients with type I aortic dissection had aortic surgery 49±55 months after routine AVR. A group of 101 controls, who did not have morphological progression of aortic diameters ≥6 years after AVR, was used to identify predictors of postsurgical dissection. Multivariate analysis identified aortic regurgitation (
P
<0.002) and fragility (
P
<0.001) or thinning of the aortic wall (
P
<0.007) at AVR as predictors, associated with a 14%, 22%, and 7% probability of late aortic dissection, respectively. Clamping times, types of valve prostheses, concomitant coronary artery bypass grafting, and mean ascending aortic diameters of 43±10 mm at AVR did not predict late dissection. A separate analysis of 29 nondissecting aneurysms of the ascending aorta developing 104±64 months after routine AVR revealed younger age at AVR (
P
<0.003) and congenitally bicuspid aortic valves (
P
<0.03) as predictors of late aneurysm formation.
Conclusions
—Aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation may reflect aortic root disease, with a high risk for postsurgical aortic sequelae if it is treated incompletely by isolated valve replacement.
Management for intraoperative acute aortic dissection during minimally invasive aortic valve replacement
