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

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.