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Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement
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  • Alessandro Verzini,
  • Marta Bargagna,
  • Guido Ascione,
  • Alessandra Sala,
  • Davide Carino,
  • Benedetto Del Forno,
  • Andrea Blasio,
  • Stefania Ruggeri,
  • Alessandro Castiglioni,
  • Ottavio Alfieri,
  • Michele De Bonis
Alessandro Verzini
San Raffaele Hospital
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Marta Bargagna
IRCCS Ospedale San Raffaele
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Guido Ascione
San Raffaele Hospital
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Alessandra Sala
Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
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Davide Carino
IRCCS Ospedale San Raffaele
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Benedetto Del Forno
San Raffaele Hospital
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Andrea Blasio
San Raffaele University Hospital
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Stefania Ruggeri
San Raffaele Hospital
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Alessandro Castiglioni
Università Vita Salute San Raffaele
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Ottavio Alfieri
S.Raffaele Hospital
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Michele De Bonis
Ospedale San Raffaele
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Abstract

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

Peer review status:ACCEPTED

23 Dec 2020Submitted to Journal of Cardiac Surgery
23 Dec 2020Assigned to Editor
23 Dec 2020Submission Checks Completed
26 Dec 2020Reviewer(s) Assigned
10 Feb 2021Review(s) Completed, Editorial Evaluation Pending
13 Feb 2021Editorial Decision: Accept