Effect of Aortic Valve Replacement on Aortic Root Dilatation Rate in Patients With Bicuspid and Tricuspid Aortic Valves

Background It remains unclear whether aortic valve replacement (AVR) has an effect on the aortic root dilatation rate in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). The present study evaluated the pre- and postoperative annual aortic root dilatation rates in BAV and TAV. Methods A total of 93 patients (67 ± 11 years; 71% men) who underwent AVR between 2003 and 2013 and had at least 2 pre- and postoperative echocardiographic studies 1 year or more apart were included in this retrospective observational study. The sinus of Valsalva (SOV), sinotubular junction (STJ) and ascending aorta (AAo) were measured in the parasternal long-axis view. Results Patients with BAV (n = 22) were significantly younger and had less coronary artery disease than patients with TAV (n = 71). At all points in time, the aortic root diameters were larger in BAV compared with TAV. Preoperatively, the STJ and AAo grew significantly faster in BAV compared with TAV (STJ, 0.27 versus 0.04 mm/y; p = 0.021; AAo, 0.42 versus 0.15 mm/y; p = 0.019). After operation, there were no significant differences in aortic root dilatation rates between BAV and TAV (SOV, –0.01 versus 0.15 mm/y; p = 0.096; STJ, 0.08 versus 0.05 mm/y; p = 0.676; AAo, 0.28 versus 0.35 mm/y; p = 0.745). Conclusions The annual aortic root dilatation rates were significantly higher in BAV compared with TAV before AVR. However, after AVR, aortic root dilatation rates were similar in BAV and TAV, suggesting an important role of hemodynamics on aortic root dilatation in BAV.