Type A aortic dissection in patients with bicuspid or tricuspid aortic valves: a retrospective comparative study in 288 Chinese patients

Abstract

Objectives: The propensity for aortic aneurysm and dissection bestows bicuspid aortic valves (BAVs), the most common congenital cardiac abnormality, a potentially lethal aspect and considerable clinical concern. In the present study, we attempted to better characterize BAV patients with acute type A aortic dissection (AAD).

Methods: Data from 288 consecutive patients undergoing surgery for acute AAD between December 2007 and April 2012 at our institute were retrospectively collected. Patients were categorized into BAV (n = 30) and tricuspid aortic valve (n = 258) groups to investigate their clinical and prognostic features.

Results: BAV patients tended to have younger age, lower systolic blood pressure, higher rate of moderate-to-severe aortic stenosis and wider ascending aorta (all P < 0.05). The 30-day postoperative mortality was significantly higher among BAV patients (23.3 vs 8.1%, P = 0.016), with an elevated proportion of both cardiogenic deaths and complications. BAV patients who died during the follow-up period demonstrated higher incidence of aortic stenosis (57.1 vs 13.0%, P = 0.033), coronary artery ostium involvement (57.1 vs 4.3%, P = 0.006) and longer cardiopulmonary bypass time (190.7 ± 67.5 vs 140.3 ± 37.1 min, P = 0.035).

Conclusions: BAV-associated dissection, as a unique subgroup of AAD, demonstrated strikingly high postoperative mortality in a Chinese population. Moderate-to-severe aortic stenosis and dissection involving coronary artery ostium might be associated with the adverse clinical outcomes among BAV patients.

Keywords: Aortic stenosis; Bicuspid; Coronary involvement; Dissection.