Comparison of the Structure of the Aortic Valve and Ascending Aorta in Adults Having Aortic Valve Replacement for Aortic Stenosis Versus for Pure Aortic Regurgitation and Resection of the Ascending Aorta for Aneurysm

• Published in: Circulation (New York, N.Y.) Vol. 123; no. 8; pp. 896 - 903
• Main Authors: CLIFFORD ROBERTS, William, JAMES VOWELS, Travis, JONG MI KO, FILARDO, Giovanni, FREDERICK HEBELER, Robert, CARL HENRY, Albert, JOHN MATTER, Gregory, LLOYD HAMMAN, Baron
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.2011
• Subjects: Adult; Aged; Aged, 80 and over; Aorta - pathology; Aorta - surgery; Aortic Aneurysm - surgery; Aortic Valve - pathology; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Elastic Tissue - pathology; Female; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - pathology; Organ Size - physiology; Retrospective Studies; Systole - physiology; Tricuspid Valve - pathology; Ascending aorta; Aortic stenosis; aortic surgery; aortic valve replacement; aortic valve stenosis; Cardiovascular disease; Aortic regurgitation; Congenital disease; Aortic aneurysm; Artery; Cardiac valvular disease; Blood vessel; Surgery; Bicuspid aortic valve; Circulatory system; Aortic valve; aortic valve regurgitation; Comparative study
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.110.972406

There is debate concerning whether an aneurysmal ascending aorta should be replaced when associated with a dysfunctioning aortic valve that is to be replaced. To examine this issue, we divided the patients by type of aortic valve dysfunction-either aortic stenosis (AS) or pure aortic regurgitation (AR)-something not previously undertaken. Of 122 patients with ascending aortic aneurysm (unassociated with aortitis or acute dissection), the aortic valve was congenitally malformed (unicuspid or bicuspid) in 58 (98%) of the 59 AS patients, and in 38 (60%) of the 63 pure AR patients. Ascending aortic medial elastic fiber loss (EFL) (graded 0 to 4+) was zero or 1+ in 53 (90%) of the AS patients, in 20 (53%) of the 38 AR patients with bicuspid valves, and in all 12 AR patients with tricuspid valves unassociated with the Marfan syndrome. An unadjusted analysis showed that, among the 96 patients with congenitally malformed valves, the 38 AR patients had a significantly higher likelihood of 2+ to 4+ EFL than the 58 AS patients (crude odds ratio: 8.78; 95% confidence interval: 2.95, 28.13). These data strongly suggest that the type of aortic valve dysfunction-AS versus pure AR-is very helpful in predicting loss of aortic medial elastic fibers in patients with ascending aortic aneurysms and aortic valve disease.