Distal aortic progression following acute type A aortic dissection repair among patients with bicuspid and tricuspid aortic valves

Objective: The study objective was to analyze long-term growth and outcomes of the distal aorta after open acute type A aortic dissection repair in patients with bicuspid aortic valves or tricuspid aortic valves without connective tissue disease. Methods: From 1996 to 2021, 60 patients with bicuspid aortic valves and 655 patients with tricuspid aortic valves without connective tissue disease underwent open repair for acute type A aortic dissection. Data were collected from the local Society of Thoracic Surgeons database, medical record review, surveys, and the National Death Index and Michigan Death Index (December 12, 2021). Results: Compared with the tricuspid aortic valve group, the bicuspid aortic valve group was signi fi cantly younger, had more severe aortic insuf fi ciency (33 % vs 22 % , P = .05), and had less hypertension (67 % vs 78 % , P = .05). Intraoperatively, patients with bicuspid aortic valves received more aortic root replacements (70 % vs 26 % , P < .001), less zone 2 aortic arch replacement (8.3 % vs 20 % , P = .03), and longer median cardiopulmonary bypass (233 vs 214 minutes, P = .05) and aortic crossclamp (184 vs 141 minutes, P < .001) times. The average annual aortic arch growth rate (0.23 mm/year vs 0.39 mm/year, P = .52) and descending aorta growth rate (0.61 mm/year vs 0.79 mm/year, P = .39) were similar between the bicuspid aortic valve and tricuspid aortic valve groups. The bicuspid aortic valve group had lower annual abdominal aorta growth (0.51 mm/year vs 0.68 mm/year, P = .03). The cumulative incidence of reoperation for the distal aorta (9.7 % vs 16.0 % , P = .77) was similar between the bicuspid aortic valve and tricuspid aortic valve groups. The 10-year survival was higher in the bicuspid aortic valve group (75.4 % vs 66.0 % , P = .03). Conclusions: Patients with bicuspid aortic valves could be treated similarly as patients with tricuspid aortic valves without connective tissue disease in the setting of open acute type A aortic dissection repair. (J Thorac Cardiovasc Surg 2024;168:453-62)