Outcomes of Bicuspid Aortic Valve Thoracic Aorta (4.0-4.5cm) after Aortic Valve Replacement.

ABSTRACT Background There is little evidence on managing the proximal aorta of 4.0-4.5 cm during aortic valve replacement (AVR) in bicuspid aortic valve (BAV) patients. Methods A total of 431 patients between 1993-2019 underwent either an isolated AVR, AVR + concomitant ascending aorta replacement, or aortic root replacement. We divided patients into native root dilation [4.0-4.5 cm, n=121] vs. root control groups [ Results Growth rate was similar between the root dilation and control groups, (both were 0.1 mm/year, p=0.56). The ascending dilation group had an aorta growth rate of 0.0 mm/year after AVR or root replacement, which was significantly different from the ascending control group (0.2 mm/year), p=0.01. Furthermore, growth rate was similar between the proximal dilation (combined root or ascending dilation) and control group (both were 0.1 mm/year, p=0.20). There were only two ascending aortic aneurysm repairs after AVR in the whole cohort. The long-term survival was similar between the root or ascending dilation groups vs. root or ascending control groups, and between the proximal dilation and control groups. Multivariable Cox regression confirmed aortic root or ascending dilation was not a significant risk factor of long-term mortality. Conclusions Our findings supported not replacing a 4.0-4.5 cm proximal thoracic aorta, including aortic root and ascending aorta, at the time of AVR for BAV patients.