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Late post-AVR progression of bicuspid aortopathy: link to hemodynamics

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Abstract

Background and aim of the study

The ascending aortic dilatation may progress after aortic valve replacement (AVR) in bicuspid aortic valve (BAV) patients. Our aim was to evaluate rheological flow patterns and histological characteristics of the aneurysmal aorta in BAV patients at the time of reoperative aortic surgery.

Materials and Methods

13 patients (mean age: 42 ± 9 years, 10 (77%) male) with significant progression of proximal aortopathy after isolated AVR surgery for BAV disease (i.e., 16.7 ± 8.1 years post-AVR) were identified by cardiac phase-contrast cine magnetic resonance imaging (MRI) in our hospital. A total of nine patients (69%) underwent redo aortic surgery. Based on the MRI data, the aortic area of the maximal flow-induced stress (jet sample) and the opposite site (control sample) were identified and corresponding samples were collected intraoperatively. Histological sum-score values [i.e. aortic wall changes were graded based on a summation of seven histological criteria (each scored from 0 to 3)] were compared between these samples.

Results

Mean proximal aortic diameter at MRI follow-up was 55 ± 6 mm (range 47–66mm). Preoperative cardiac MRI demonstrated eccentric systolic flow pattern directed towards right-lateral/right posterior wall of the proximal aorta in 9/13 (69%) patients. Histological sum-score values were significantly higher in the jet sample vs control sample (i.e., 8.3 ± 3.8 vs 5.6 ± 2.4, respectively, p = 0.04).

Conclusions

Hemodynamic factors may still be involved in the late progression of bicuspid aortopathy even after isolated AVR surgery for BAV disease.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany

    Shiho Naito, Tatiana Gross, Hermann Reichenspurner & Evaldas Girdauskas

  2. Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany

    Kushtrim Disha

  3. Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany

    Yskert von Kodolitsch

Authors
  1. Shiho Naito
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  2. Tatiana Gross
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  3. Kushtrim Disha
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  4. Yskert von Kodolitsch
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  5. Hermann Reichenspurner
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  6. Evaldas Girdauskas
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Corresponding author

Correspondence to Shiho Naito.

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Conflict of interest

The author, Shiho Naito received the travel grant from Japan surgical society.

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Naito, S., Gross, T., Disha, K. et al. Late post-AVR progression of bicuspid aortopathy: link to hemodynamics. Gen Thorac Cardiovasc Surg 65, 252–258 (2017). https://doi.org/10.1007/s11748-017-0746-4

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  • DOI: https://doi.org/10.1007/s11748-017-0746-4

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