Introduction
Bicuspid aortic valve (BAV) is a very common congenital valvular malformation, with a prevalence of 0.9~2% in general population.1-3 Aortic valve degeneration is the main problem for these patients, approximately half of them requiring aortic valve replacement (AVR) because of valvular stenosis, regurgitation or infective endocarditis. Even in the absence of aortic valve dysfunction, they may be associated with a high risk of ascending aortic dilatation, which leads to aortic aneurysm and dissection.4
The ascending aorta of BAV may still dilate progressively after AVR, which leads to an increased risk of adverse aortic complication (ie., aortic dissection and rupture).5 As a result , the recent American College of Cardiology/ American Heart Association guidelines indicated replacement of the moderately enlarged ascending aorta(>45mm) in case of concomitant surgery of valvular heart disease.6 Some centers have even adopted a more aggressive surgical strategy, relaxing the indication for proximal aortic surgery to 40mm in diameter. Moreover, Russo and colleagues proposed a “prophylactic” replacement of the ascending aorta in young BAV patients regardless of its size.7 This phenomenon was based on the hypothesis of genetic aortopathy in BAV. However, there were also some researchers questioning such an aggressive surgical approach.8, 9
The majority of researches focused on the dilated ascending aorta, there are few data on the progression of normal-sized ascending aorta after AVR in BAV population with respect to those with tricuspid aortic valve (TAV). Therefore, we retrospectively analyzed the clinical data of patients undergoing AVR in our institution, and evaluated the progression of unreplaced ascending aorta in a relatively long term follow-up.