Comment
BAV is the most common congenital cardiac anomaly1 and
its correlation with thoracic aortic disease is well established, so as
to be defined “BAV aortopathy”9,10. Within thoracic
aortic aneurysm, supracoronary ascending aorta dilatation results to be
the prevalent phenotype2,3,11. In our cohort the most
relevant BAV phenotype were BAV type 0 antero-posterior (55/75, 73%)
and BAV type 1 left-right (17/75, 23%), these results do not differ
from the findings by Sievers and coworkers12 who had
previously investigated the association with BAV phenotype and aortic
configuration. Michelena and coworkers, analyzing a cohort of 212
patients with normal functioning BAV13, reported that
20 years after the diagnosis 5 ± 2% of the patients required ascending
aorta surgery for aneurysmal degeneration, while AVR was required in 24
± 4 % of the patients. Similarly, Russo and
coworkers5,6 analyzing a cohort of 40 patients
undergoing supra-coronary ascending aorta replacement with normally
functioning BAV reported that , after a mean follow-up 93 ± 50 months,
only 4 patients required AVR, 3 for aortic regurgitation and 1 for
aortic stenosis and at 10-years, they reported that freedom from cardiac
death was 83 ± 16%. Likewise, Vinholo and coworkers7published the long-term (mean echocardiography follow up 4,50 ± 4,09
years) results of 23 patients with none or trace of aortic regurgitation
or stenosis who underwent ascending aorta replacement without aortic
valve replacement. In this group, 5 patients showed a progression of the
aortic regurgitation or stenosis from none to mild and 2 patients from
none to severe. Only 1 patient required aortic valve replacement during
follow up. Differently, we analyzed the evolution of the BAV disease in
patients undergoing supracoronary ascending aorta replacement who, at
the time of aortic surgery, already presented moderate (33/75, 44%) or
mild (42/75, 56%) aortic regurgitation. During the follow up, only 1
patient presented a worsening of the AR, while 3 patients developed
aortic stenosis more than moderate. Of these 2 needed AVR: 1 surgical
and 1 trans-catheter. Moreover 1 patient required re-operation for
endocarditis. These data showed good durability of the BAV preserved
during supracoronary ascending aorta replacement.
No patients required reoperation for aortic root dilatation, as reported
in previous studies14,15. No cardiac deaths occurred.