Factors Influencing the Decision Process to Replace the Ascending Aorta in Patients with Bicuspid Aortic Valves: Insights from 1693 Patients

Introduction: Bicuspid aortic valve (BAV) disease is frequent and is associated with dilatation of the ascending aorta which brings in an increased risk for life threatening aortic events. Aim of the present study was to investigate our decision-making process for the treatment of the ascending in patients with bicuspid aortic valves undergoing surgery.

Methods: Our patient population consisted of 1693 patients with primary indication for aortic valve surgery. We retrospectively investigated our multifactorial decision-making process including absolute diameters of the ascending aorta, z-scores, clinical and somatometric characteristics and we correlated these factors with clinical outcomes. Follow-up was 99.5% complete (mean 7.0 ± 4.4 years, range 0–17.7 years, 11895 patient-years).

Results: Replacement of the ascending aorta did not lead to an increased hospital mortality (1.2% versus 0.9%;p = 0.629). Determinants for death were not related to the ascending aorta treatment. Aortoplasty led to significantly more reoperations (p = 0.002). The z-score thresholds for intervention on the ascending aorta were significantly higher in younger patients and interventions in the ascending aorta was more liberal in young aged patients.

Conclusions: In our study ascending aorta intervention could be performed with low hospital mortality and obviously did not add to the overall mortality compared with no intervention. Ascending aorta replacement was the most definite intervention. The multifactorial decision for ascending aorta intervention including the z-score of the ascending aorta was more liberal in younger patients compared with the simple aortic size guidelines and provided excellent results.