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J Thorac Cardiovasc Surg 2008;136:937-942
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Is aortic wall degeneration related to bicuspid aortic valve anatomy in patients with valvular disease?

^a Angelo De Gasperis Department of Cardiac Surgery, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy
^b Pathology Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy

Received for publication July 10, 2007; revisions received November 13, 2007; accepted for publication November 26, 2007.

^_* Address for reprints: Aldo Cannata, MD, Angelo De Gasperis Department of Cardiac Surgery, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore, 3. 20162, Milan, Italy. (Email: aldo.cannata{at}libero.it).

Objective: Patients with bicuspid aortic valve are at increased risk for aortic complications.

Methods: A total of 115 consecutive patients with bicuspid aortic valve disease underwent surgery of the ascending aorta. We classified the cusp configuration by 3 types: fusion of left coronary and right coronary cusps (type A), fusion of right coronary and noncoronary cusps (type B), and fusion of left coronary and noncoronary cusps (type C). Histopathologic changes in the ascending aortic wall were graded (aortic wall score).

Results: We observed type A fusion in 85 patients (73.9%), type B fusion in 28 patients (24.3%), and type C fusion in 2 patients (1.8%). Patients with type A fusion were younger at operation than patients with type B fusion (51.3 ± 15.5 years vs 58.7 ± 7.6 years, respectively; P = .034). The mean ascending aorta diameter was 48.9 ± 5.0 mm and 48.7 ± 5.7 mm in type A and type B fusion groups, respectively (P = .34). The mean aortic root diameter was significantly larger in type A fusion (4.9 ± 6.7 mm vs 32.7 ± 2.8 mm; P < .0001). The aortic wall score was significantly higher in type A fusion than in type B fusion (P = .02). The prevalence of aortic wall histopathologic changes was significantly higher in type A fusion. Moreover, there were no statistically significant differences between type A and type B fusion in terms of prevalence of bicuspid aortic valve stenosis, regurgitation, or mixed disease.

Conclusion: In diseased bicuspid aortic valves, there was a statistically significant association between type A valve anatomy and a more severe degree of wall degeneration in the ascending aorta and dilatation of the aortic root at younger age compared with type B valve anatomy.

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