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.
Late Aortic Dissection after Aortic Valve Replacement for Aortic Regurgitation with Slight Aortic Dilatation Successfully Repaired by the Bentall Procedure.
