J Thorac Cardiovasc Surg 2008;136:1604-1606
© 2008 The American Association for Thoracic Surgery
Reply to the Editor
Shafie S. Fazel, MD, PhD,
D. Craig Miller, MD
Department of Cardiothoracic Surgery, Stanford University Medical School, Stanford, Calif
| The first 20% of the full text of this article appears below. |
We thank Della Corte and Cotrufo from Naples for their interest in our observations and for raising several critical points concerning the "aortopathy" associated with bicuspid aortic valve (BAV) disease. Owing to space limitations, we can only discuss the important question of extent of aortic resection at the time of operation, particularly in light of the recent condemnation of the more aggressive American College of Cardiology/American Heart Association guidelines by Guntheroth.1
Primum non nocere. We agree with this principle and uphold it in our clinical practice. On all too numerous occasions we have surgically treated BAV patients who have undergone previous aortic valve replacement (AVR) with or without ascending aortic replacement who present with a large aortic arch aneurysm, pseudoaneurysm, or dissection, sometimes annealed to the posterior table of the sternum, which can mandate cooling and circulatory arrest before completing the redo sternotomy. These are challenging redo cases in the best of hands. The situation might possibly have been avoided if more complete resection of the dilated aorta at the time of initial procedure had been carried out. Della Corte and Cotrufo over the years have done a superb job describing the various histologic and pathologic characterizations of the aorta of patients with a BAV and have highlighted that a diseased . . . [Full Text of this Article]
Copyright © 2008 by The American Association for Thoracic Surgery.
