Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
Ann Thorac Surg. 2010 Dec;90(6):1884-90; discussion 1891-2. doi: 10.1016/j.athoracsur.2010.06.115.
Bicuspid aortic valves (BAV) are frequently associated with root/ascending aorta dilatation, but there is controversy regarding when to operate to prevent dissection of a dilated aorta associated with a well-functioning BAV.
From 1988 through 2008, 158 patients (mean age: 56 ± 13.5 years) with a dilated ascending aorta (AA) and a well-functioning BAV were referred to our institution. All patients underwent computed tomographic (CT) scanning and digitization to calculate mean AA diameter. Forty-two patients underwent operation a median of 52 days after initial CT scan with a mean AA diameter of 5.6 ± 0.5 cm. One hundred sixteen patients (mean diameter 4.6 ± 0.5 cm) were enrolled in annual or semiannual surveillance. Seventy-one patients, 45 with 2 or more CT scans, are still under surveillance.
Average follow-up was 6.5 ± 4.1 years. Overall survival after the first encounter was 93% at 5 years and 85% at 10 years. A total of 87 of 158 patients had a Bentall or Yacoub procedure, with two hospital deaths (2.3%). Mean duration of surveillance in the 116 patients without immediate operation was 4.2 ± 2.9 years (481 patient-years). Average growth rate of the AA in patients with 2 scans or greater was 0.77 mm/year (p < 0.0001 versus normal population) with no significant impact of hypertension, sex, smoking or age. Forty-five of the 116 surveillance patients underwent operation after a mean of 3.4 ± 2.9 years (mean age 55 ± 14.7 years; mean AA diameter 4.9 ± 0.6 cm). Six patients died without surgery, median age 82 (range, 44 to 87) years, but none within one year of the last CT scan.
A consistent approach to patients with a well-functioning BAV and AA dilatation, recommending operation to those with an AA diameter greater than 5 cm and deferring operation in patients under surveillance in the absence of significant enlargement (>0.5 cm/year), resulted in overall survival equivalent to a normal age-matched and sex-matched population. Operation was necessary in approximately 10% of patients under surveillance each year.
二叶式主动脉瓣（BAV）常与根部/升主动脉扩张相关，但对于何时进行手术以预防与功能良好的 BAV 相关的扩张主动脉夹层，存在争议。
1988 年至 2008 年，158 例升主动脉扩张（AA）和功能良好的 BAV 患者被转诊至我院。所有患者均接受 CT 扫描和数字化处理以计算平均 AA 直径。42 例患者在初始 CT 扫描后中位 52 天进行手术，平均 AA 直径为 5.6±0.5cm。116 例患者（平均直径 4.6±0.5cm）接受年度或半年度监测。71 例患者（45 例有 2 次或以上 CT 扫描）仍在监测中。
平均随访 6.5±4.1 年。首次就诊后整体 5 年生存率为 93%，10 年生存率为 85%。158 例患者中共有 87 例接受了 Bentall 或 Yacoub 手术，2 例院内死亡（2.3%）。116 例未立即手术患者的中位监测时间为 4.2±2.9 年（481 患者-年）。2 次或以上 CT 扫描的患者 AA 的平均生长速度为 0.77mm/年（p<0.0001 与正常人群相比），高血压、性别、吸烟或年龄无显著影响。116 例监测患者中有 45 例在平均 3.4±2.9 年后接受手术（平均年龄 55±14.7 岁；平均 AA 直径 4.9±0.6cm）。6 例患者未经手术死亡，中位年龄 82 岁（范围 44 至 87 岁），但最后一次 CT 扫描后 1 年内无一例死亡。
对功能良好的 BAV 和 AA 扩张患者采用一致的治疗方法，建议 AA 直径大于 5cm 的患者进行手术，而在无明显增大（>0.5cm/年）的情况下对监测患者进行手术，总体生存率与正常年龄和性别匹配的人群相当。每年约有 10%的监测患者需要手术。
