Long-term Fate of Dilated Ascending Aorta after Aortic Valve Replacement for Bicuspid versus Tricuspid Aortic Valve Disease

Abstract We compared the long-term outcomes and difference in dilatation rates of the ascending aorta after aortic valve (AV) replacement (AVR) between bicuspid and tricuspid AV patients, and evaluated risk factors associated with ascending aorta dilatation and aortic events during the follow-up. Of 1,127 patients who underwent AVR from 1995 to 2015, 259 patients with a dilated ascending aorta (≥40 mm in diameter) were included. The patients were divided into those with bicuspid (group BAV, n=105) and with tricuspid (group TAV, n=154) AV, and a propensity score-matched analysis was performed to match 98 patients in each group. The differences in the dilation rate of the ascending aorta and long-term outcomes were analyzed. Risk factors for ascending aorta dilatation, mortality, and aortic events were identified. Follow-up was completed in 100% of patients with a median follow-up duration of 106.1[68.8, 163.0] months. The early clinical outcomes and dilation rate of the ascending aorta were similar between the groups. Overall survivals up to 15 years postoperatively were similar between groups BAV and TAV (P=.223). Aortic events occurred in six patients (groups BAV vs TAV, 2 vs 4;P=.678). Preoperative ascending aorta diameter showed a linear relationship with the dilatation rate of ascending aorta (P