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General Thoracic and Cardiovascular Surgery

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01-09-2023 | Aortic Valve Replacement | Original Article

Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve

Authors: Yuki Tamagawa, Masashi Kawamura, Kana Shibata, Satoshi Asada, Masahiro Ryugo, Yasush i Tsutsumi, Osamu Monta

Published in: General Thoracic and Cardiovascular Surgery | Issue 5/2024

Abstract

Objective

Aortic dilatation concurrent with aortic valve disease is a common condition. However, the incidence of aortic dissection after aortic valve replacement for tricuspid aortic valve has not been fully investigated. Therefore, we performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve.

Methods

We retrospectively reviewed 599 patients who underwent aortic valve replacement at our hospital between January 2000 and December 2020. We performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve.

Results

Seven patients developed late aortic dissections during the follow-up period. All patients with aortic dissection underwent aortic valve replacement for aortic regurgitation. Multivariable analysis revealed that aortic regurgitation was an independent predictor of aortic dissection (p < 0.0001). The mean ascending aortic diameter at aortic valve replacement for aortic regurgitation was significantly greater in patients with aortic dissection than in those without aortic dissection (46 [43.5–46] mm vs. 39 [36–42] mm, p < 0.001). The predictive cutoff value of ascending aortic diameter was indicated using receiver operating characteristic curve analysis; 46.0 mm (area under the curve: 0.8987). Freedom rates from aortic dissection in patients with aortic regurgitation and an ascending aortic diameter ≥ 46 mm were significantly lower than those in patients with an ascending aortic diameter < 46 mm (66.7% vs. 100% at 5 years, p < 0.0001).

Conclusion

Aortic regurgitation combined with ascending aortic dilatation at aortic valve replacement could be a significant risk factor for late aortic dissection.

Crawford MH, Roldan CA. Prevalence of aortic root dilatation and small aortic roots in valvular aortic stenosis. Am J Cardiol. 2001;87(11):1311–3. https://doi.org/10.1016/s0002-9149(01)01530-2.CrossRefPubMed

Gaudino M, Anselmi A, Morelli M, Pragliola C, Tsiopoulos V, Glieca F, et al. Aortic expansion rate in patients with dilated post-stenotic ascending aorta submitted only to aortic valve replacement long-term follow-up. J Am Coll Cardiol. 2011;58(6):581–4. https://doi.org/10.1016/j.jacc.2011.03.040.CrossRefPubMed

Lee SH, Kim JB, Kim DH, Jung SH, Choo SJ, Chung CH, et al. Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement. J Thorac Cardiovasc Surg. 2013;146(4):802–9. https://doi.org/10.1016/j.jtcvs.2013.06.007.CrossRefPubMed

Estrera AL, Miller CC, Kaneko T, Lee TY, Walkes JC, Kaiser LR, et al. Outcomes of acute Type A aortic dissection after previous cardiac surgery. Ann Thorac Surg. 2010;89:1467–74. https://doi.org/10.1016/j.athoracsur.2010.02.015.CrossRefPubMed

Özçınar E, Çakıcı M, Baran Ç, Gümüş F, Özgür A, Yazıcıoğlu L, et al. Results of late-onset type A aortic dissection after previous cardiac surgery: does prior coronary artery bypass grafting affect survival? Turk Gogus Kalp Damar Cerrahisi Derg. 2018;26:1–7. https://doi.org/10.5606/tgkdc.dergisi.2018.14683.CrossRefPubMedPubMedCentral

Klodell CT, Karimi A, Beaver TM, Hess PJ, Martin TD. Outcomes for acute type A aortic dissection: effects of previous cardiac surgery. Ann Thorac Surg. 2012;93:1206–14. https://doi.org/10.1016/j.athoracsur.2011.12.076.CrossRefPubMed

Borger MA, Preston M, Ivanov J, Fedak PW, Davierwala P, Armstrong S, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg. 2004;128:677–83. https://doi.org/10.1016/j.jtcvs.2004.07.009.CrossRefPubMed

Itagaki S, Chikwe JP, Chiang YP, Egorova NN, Adams DH. Long-term risk for aortic complications after aortic valve replacement in patients with bicuspid aortic valve versus Marfan syndrome. J Am Coll Cardiol. 2015;65:2363–9. https://doi.org/10.1016/j.jacc.2015.03.575.CrossRefPubMed

Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J. 2020;84:2037–119. https://doi.org/10.1253/circj.CJ-20-0135.CrossRefPubMed

10.

Wang Y, Wu B, Li J, Dong L, Wang C, Shu X. Impact of aortic insufficiency on ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement in patients with a bicuspid aortic valve. Ann Thorac Surg. 2016;101:1707–14. https://doi.org/10.1016/j.athoracsur.2015.10.047.CrossRefPubMed

11.

Girdauskas E, Rouman M, Disha K, Espinoza A, Misfeld M, Borger MA, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease. J Am Coll Cardiol. 2015;66:1409–11. https://doi.org/10.1016/j.jacc.2015.07.022.CrossRefPubMed

12.

von Kodolitsch Y, Simic O, Schwartz A, Dresler C, Loose R, Staudt M, et al. Predictors of proximal aortic dissection at the time of aortic valve replacement. Circulation. 1999;100(Suppl 2):287–94. https://doi.org/10.1161/01.cir.100.suppl_2.ii-287.CrossRef

13.

Tsutsumi K, Inoue Y, Hashizume K, Kimura N, Takahashi R. Risk factor analysis for acute type A aortic dissection after aortic valve replacement. Gen Thorac Cardiovasc Surg. 2010;58:601–5. https://doi.org/10.1007/s11748-010-0658-z.CrossRefPubMed

14.

Sequeira Gross TM, Lindner D, Ojeda FM, Neumann J, Grewal N, Kuntze T, et al. Comparison of microstructural alterations in the proximal aorta between aortic stenosis and regurgitation. J Thorac Cardiovasc Surg. 2021;162:1684–95. https://doi.org/10.1016/j.jtcvs.2020.03.002.CrossRefPubMed

15.

Roberts WC, Vowels TJ, Ko JM, Filardo G, Hebeler RF Jr, Henry AC, et al. 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. Circulation. 2011;123:896–903. https://doi.org/10.1161/CIRCULATIONAHA.110.972406.CrossRefPubMed

16.

Benedik J, Pilarzcyk K, Wendt D, Price V, Tsagakis K, Perrey M, et al. Is there any difference in aortic wall quality between patients with aortic stenosis and those with regurgitation? Eur J Cardiothorac Surg. 2013;44:754–9. https://doi.org/10.1093/ejcts/ezt123.CrossRefPubMed

17.

Balint B, Federspiel JM, Schwab T, Ehrlich T, Ramsthaler F, Schäfers HJ. Aortic regurgitation is associated with ascending aortic remodeling in the nondilated aorta. Arterioscler Thromb Vasc Biol. 2021;41:1179–90. https://doi.org/10.1161/ATVBAHA.120.315739.CrossRefPubMed

18.

van Ooij P, Markl M, Collins JD, Carr JC, Rigsby C, Bonow RO, et al. Aortic valve stenosis alters expression of regional aortic wall shear stress: new insights from a 4-dimensional flow magnetic resonance imaging study of 571 subjects. J Am Heart Assoc. 2017;6:e005959. https://doi.org/10.1161/JAHA.117.005959.CrossRefPubMedPubMedCentral

19.

Girdauskas E, Rouman M, Disha K, Scholle T, Fey B, Theis B, et al. Correlation between systolic transvalvular flow and proximal aortic wall changes in bicuspid aortic valve stenosis. Eur J Cardiothorac Surg. 2014;46:234–9. https://doi.org/10.1093/ejcts/ezt610.CrossRefPubMed

20.

Guzzardi DG, Barker AJ, van Ooij P, Malaisrie SC, Puthumana JJ, Belke DD, et al. Valve-related hemodynamics mediate human bicuspid aortopathy: insights from wall shear stress mapping. J Am Coll Cardiol. 2015;66:892–900. https://doi.org/10.1016/j.jacc.2015.06.1310.CrossRefPubMedPubMedCentral

21.

Shan Y, Li J, Wang Y, Wu B, Barker AJ, Markl M, et al. Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency. J Thorac Cardiovasc Surg. 2017;153:1263-72.e1. https://doi.org/10.1016/j.jtcvs.2016.12.059.CrossRefPubMedPubMedCentral

22.

van Ooij P, Potters WV, Nederveen AJ, Allen BD, Collins J, Carr J, et al. A methodology to detect abnormal relative wall shear stress on the full surface of the thoracic aorta using four-dimensional flow MRI. Magn Reson Med. 2015;73:1216–27. https://doi.org/10.1002/mrm.25224.CrossRefPubMed

23.

Bieging ET, Frydrychowicz A, Wentland A, Landgraf BR, Johnson KM, Wieben O, et al. In vivo three-dimensional MR wall shear stress estimation in ascending aortic dilatation. J Magn Reson Imaging. 2011;33:589–97. https://doi.org/10.1002/jmri.22485.CrossRefPubMed

24.

Bürk J, Blanke P, Stankovic Z, Barker A, Russe M, Geiger J, et al. Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR. J Cardiovasc Magn Reson. 2012;14:84. https://doi.org/10.1186/1532-429X-14-84.CrossRefPubMedPubMedCentral

Title: Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve
Authors: Yuki Tamagawa
Masashi Kawamura
Kana Shibata
Satoshi Asada
Masahiro Ryugo
Yasush i Tsutsumi
Osamu Monta
Publication date: 01-09-2023
Publisher: Springer Nature Singapore
Keywords: Aortic Valve Replacement
Aortic Valve Replacement
Aortic Valve Replacement
Aortic Dissection
Published in: General Thoracic and Cardiovascular Surgery / Issue 5/2024
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-023-01970-3

At a glance: The STEP trials

Springer Medicine

Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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