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.