[HSF] Bicuspid aortic valve and dilated ascending aorta

[Giuseppe Rescigno]

Radicality in  surgery is a difficult concept to adopt. If there is any complication related to a radicality choice, there will always be a "monday coach"  into the rest room of the operating theater saying that it was useless, dangerous, etc. If you do not replace this aorta, as it is generally indicated, the problem will be delayed and it will probably fall on the back of another surgeon. Meanwhile the patient will feel that everything was ok.... 

Giuseppe


Giuseppe Rescigno M.D.
Cardiothoracic Surgeon

Lancisi Hospital
Torrette - Ancona
Italy


 
On Friday, April 27, 2007, at 03:19PM, "Jean BACHET" <jean.bachet at imm.fr> wrote:
>Tom Martin is 300% right!
>
>Dilated ascending aortas and/or aortic roots should be replaced in BAV patients whenever their diameter reaches 40 to 45 mm.
>If some one needs  more scientific information here are two good papers, dealing with this topic:
>
> 
>Borger 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 
>
>Von Kodolitsh Y et al. Predictors of proximal aortic dissection at the time of aortic valve replacement 
>Circulation 1999; 100 (supp II) II: 287-94
>
>Jean BACHET,
>Institut Mutualiste Montsouris 
>Paris France
>----- Original Message ----- 
>From: <tdmartin2000 at aol.com>
>To: <OpenHeart-L at lists.hsforum.com>
>Sent: Friday, April 27, 2007 6:15 AM
>Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>
>
>> Sorry I have not responded to this earlier but I have been too busy doing redo complete sternotomies for patients that had previous bicuspid aortic valves replaced with "dilated" (4 cm) aortas. 
>> That is supposed to be funny but in reality I just did a redo in a patient that had a bicuspid AVR several yrs ago and was refered to me with a 7 cm ascending. I actually see quite a few pts also that have had previous bicspid AVR's that come to us with acute dissections. Patients with bicuspid aortic valves and dilated ascendings have abnormal collagen and WILL have a problem in the future.
>> My advice in this area is- at the minimum AVR plus ascending if the aorta is 4cm or greater and if the sinuses are significantly enlarged, do a root.
>> As for the "mini" sternotomy or minimally invasive approach to the aortic valve my question is WHY!? There is no real benefit to the patient in any fashion and it is harder to do.
>>  
>> Tom Martin
>> U of Florida
>> Gainesville
>>  
>>  
>> -----Original Message-----
>> From: prasannasimha at gmail.com
>> To: OpenHeart-L at lists.hsforum.com
>> Sent: Mon, 23 Apr 2007 10:27 PM
>> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>> 
>> 
>> 5.0 cm does not merit "prophylactic " replacement of the ascending aorta. 
>> Prasanna 
>>  
>> Zhandong Zhou wrote: 
>> > To Forum, 
>> > 
>> > I have a 51 year old patient with bicuspid aortic valve, severe AR > with 4.0 cm root. choices between mini-invasive AVR (through 2nd > intercostal space, 2.5 inch incision) vs full sternotomy with Bentall. > I personally prefer mini AVR then see what happens in the future. 
>> > 
>> > Any suggestions? 
>> > 
>> > Z Zhou 
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