Stability of ascending aortic dilatation following aortic valve replacement

Background - Replacement of the ascending aorta (Asc Ao) at the time of aortic valve replacement (AVR) is controversial because the risk of progressive dilatation following valve replacement is uncertain. Our aim was to determine the natural history of ascending aortic dilatation following AVR. Methods and Results - We studied 185 patients undergoing AVR at our institution between 1992 and 1999. Clinical and echocardiographic data were obtained by merging our institutional echocardiographic database with the DHMC component of the Northern New England Cardiovascular Disease Study Group database. Baseline Asc Ao measurements obtained from intraoperative transesophageal echocardiograms or early ( < 8 weeks) postoperative transthoracic echocardiograms were compared with late follow-up measurements ( mean follow-up 30.0 +/- 23.4 months). During follow-up, there was no increase in the mean Asc Ao diameter ( 3.6 +/- 0.6 cm versus 3.6 +/- 0.6 cm, p = NS). Progressive aortic dilatation, defined as an increase in diameter > 0.3 cm, occurred in 27/185 patients (15%). Baseline Asc Ao dilatation ( greater than or equal to 3.5 cm) was present in 107/185 patients (58%). In this subset of patients, there was no increase in mean Asc Ao diameter ( 4.0 +/- 0.4 versus 3.9 +/- 0.6 cm, p = NS) and progressive aortic dilatation occurred in only 10 patients (9.3%). No patients with baseline aortic dilatation ( range, 3.5 to 5.3 cm) dilated beyond 5.5 cm on follow-up ( range, 2.4 to 5.5 cm). There were no clinical or valvular characteristics that predicted progressive Asc Ao dilatation. Conclusions - An increase in Asc Ao dilatation occurs infrequently following AVR and therefore, argues against routine Asc Ao replacement at the time of AVR.