Options for repair of a bicuspid aortic valve and ascending aortic aneurysm

Background. Intrinsic abnormality of the aortic wall may explain the associ ation of bicuspid aortic valves with ascending aortic aneurysms. Separate v alve and graft repair of such lesions, rather than composite Valve graft re placement, is more straightforward but leaves potentially abnormal sinuses behind. Methods. Between January 1985 and January 1998, 45 patients underwent separ ate valve and graft (n = 27) or composite valve graft (n = 18) for an ascen ding aortic aneurysm and bicuspid aortic valve. Perioperative events and la te results were compared. Results. Patients undergoing separate valve and graft were older (mean age, 60 a 13 vs 42 +/- 12 years, p < 0.001) and were more likely to have purely stenotic (48% vs 6%, p = 0.003) than purely regurgitant (11% vs 72%, p < 0 .001) disease. They were also more likely to require concomitant coronary a rtery bypass grafting (56% vs 6%, p = 0.001). There were no significant dif ferences in operative risk and no known late complications related to recur rent aneurysms. Conclusions. Root replacement with a composite valve graft can be accomplis hed with low operative risk and is the first choice for repair of this lesi on. Separate valve and graft repair, however, yields satisfactory early and late results and remains an acceptable option, especially when the coronar y ostea are not displaced or when concomitant procedures must be performed. (C) 2000 by The Society of Thoracic Surgeons.