Comparison of Reduction Ascending Aortoplasty and Ascending Aortic Replacement for Bicuspid Valve Related Aortopathy in Young Adult Patients Undergoing Aortic Valve Replacement—Long-Term Follow-Up

BackgroundWe aimed to determine the long-term outcomes of reduction ascending aortoplasty and ascending aortic replacement. A secondary aim was to document our experience with the long-term “growth” of woven Dacron grafts.MethodsOver a nine-year period (1992–2001), 154 patients underwent aortic valve replacement using the Ross procedure for bicuspid aortic valve disease (BAV). Twenty-five also underwent reduction ascending aortoplasty (RAA), and 16 underwent ascending aorta replacement (AAR), using a Dacron graft. Preoperative diameters were measured prospectively. Patients had a follow-up CT chest between January and December 2007 to measure the mid-ascending aortic diameter.ResultsMean age at operation was 31.8 ± 13.5 years (RAA), and 40.0 ± 8.6 years (AAR) (p = NS). Mean follow-up was 101 months (±43.0, 95% CI) in the RAA group, and 107 months (±29.0, 95% CI) in the AAR group. Mean pre-operative diameter in the RAA group was 41.5 mm (±11.8, 95% CI) and in the AAR group 46.2 mm (±7.8, 95% CI) (p = 0.004). Mean follow-up diameter in the RAA group was 35.4 mm (±4.6, 95% CI) and in the AAR group 31.9 mm (±6.8, 95% CI) (p = 0.003). Growth of the woven Dacron prosthesis was 23.4% (±26.8, 95% CI) in the 107-month follow-up period. There was no early or late mortality and no further aortic surgery during follow-up.ConclusionsWe have demonstrated satisfactory long-term outcomes with both RAA and AAR in patients with BAV related aortopathy who have undergone the Ross procedure. We have noted a greater diameter reduction with AAR when compared with RAA over nine years.In this series, “growth” of the woven Dacron grafts occurred, however individual measures did not correlate with other studies.