Heart, Lung and Circulation
Original Article| Volume 18, ISSUE 5, P337-342, October 2009

Comparison of Reduction Ascending Aortoplasty and Ascending Aortic Replacement for Bicuspid Valve Related Aortopathy in Young Adult Patients Undergoing Aortic Valve Replacement—Long-Term Follow-Up


      We aimed to determine the long-term outcomes of reduction ascending aortoplasty and ascending aortic replacement. A secondary aim was to document our experience with the long-term “growth” of woven Dacron grafts.


      Over a nine-year period (1992–2001), 154 patients underwent aortic valve replacement using the Ross procedure for bicuspid aortic valve disease (BAV). Twenty-five also underwent reduction ascending aortoplasty (RAA), and 16 underwent ascending aorta replacement (AAR), using a Dacron graft. Preoperative diameters were measured prospectively. Patients had a follow-up CT chest between January and December 2007 to measure the mid-ascending aortic diameter.


      Mean age at operation was 31.8 ± 13.5 years (RAA), and 40.0 ± 8.6 years (AAR) (p = NS). Mean follow-up was 101 months (±43.0, 95% CI) in the RAA group, and 107 months (±29.0, 95% CI) in the AAR group. Mean pre-operative diameter in the RAA group was 41.5 mm (±11.8, 95% CI) and in the AAR group 46.2 mm (±7.8, 95% CI) (p = 0.004). Mean follow-up diameter in the RAA group was 35.4 mm (±4.6, 95% CI) and in the AAR group 31.9 mm (±6.8, 95% CI) (p = 0.003). Growth of the woven Dacron prosthesis was 23.4% (±26.8, 95% CI) in the 107-month follow-up period. There was no early or late mortality and no further aortic surgery during follow-up.


      We have demonstrated satisfactory long-term outcomes with both RAA and AAR in patients with BAV related aortopathy who have undergone the Ross procedure. We have noted a greater diameter reduction with AAR when compared with RAA over nine years.
      In this series, “growth” of the woven Dacron grafts occurred, however individual measures did not correlate with other studies.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Roberts W.C.
        The congenitally bicuspid aortic valve. A study of 85 autopsy cases.
        Am J Cardiol. 1970; 26: 72-83
        • Kuralay E.
        • Demirkilic U.
        • Ozal E.
        • Savas B.
        • Cingoz F.
        • Gunay C.
        • Ceylan S.
        • Arslan M.
        • Tatar H.
        Surgical approach to ascending aorta in bicuspid aortic valve.
        J Cardiovasc Surg. 2003; 18: 173-180
        • Fedak P.W.M.
        • Verma S.
        • David T.E.
        • Leask R.L.
        • Weisel R.D.
        • Butany J.
        Clinical and pathophysiological implications of a bicuspid aortic valve.
        Circulation. 2002; 106: 900-904
        • Braverman A.C.
        • Guven H.
        • Beardslee M.A.
        • Makan M.
        • Kates A.M.
        • Moon M.R.
        The bicuspid aortic valve.
        Curr Prob Cardiol. 2005; 30: 470-522
        • Carrel T.
        • von Segesser L.
        • Jenni R.
        • Gallino A.
        • Egloff L.
        • Bauer E.
        • Laske A.
        • Turina A.
        Dealing with dilated ascending aorta during aortic valve replacement: advantages of conservative surgical approach.
        Eur J Cardiothor Surg. 1991; 67: 1834-1839
        • Ergin M.A.
        • Spielvogel D.
        • Apaydin A.
        • Lansman S.L.
        • McCullough J.N.
        • Galla J.D.
        • Griepp R.B.
        Surgical treatment of the dilated ascending aorta: when and how?.
        Ann Thorac Surg. 1999; 67: 1834-1839
        • Kouchoukos N.T.
        • Wareing T.H.
        • Murphy S.F.
        • Perrillo J.B.
        Sixteen-year experience with aortic root replacement. Results of 172 operations.
        Ann Thorac Surg. 1991; 214: 308-318
        • Robicsek F.
        • Cook J.W.
        • Reames M.K.
        • Skipper E.R.
        Size reduction ascending aortoplasty: is it dead or alive?.
        J Thorac Cardiovasc Surg. 2004; 128: 562-570
        • Barnett M.G.
        • Fiore A.C.
        • Vaca K.J.
        • Milligan T.W.
        • Barner H.B.
        Tailoring aortoplasty for repair of fusiform ascending aortic aneurysms.
        Ann Thorac Surg. 1995; 59: 497-551
        • Feindt P.
        • Litmathe J.
        • Borgens A.
        • Boeken U.
        • Kurt M.
        • Gams E.
        Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery?.
        Eur J Cardiothorac Surg. 2007; 31: 614-617
        • Bail D.H.
        • Walker T.
        • Gruler M.
        • Ziemer G.
        Preserved Windkessel function in patients following reduction aortoplasty of the ascending aorta.
        Echocardiography. 2007; 24: 457-463
        • Davies R.R.
        • Kaple R.K.
        • Mandapati D.
        • Gallo A.
        • Botta D.M.
        • Elefteriades J.A.
        • Coady M.A.
        Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve.
        Ann Thorac Surg. 2007; 83: 1338-1344
        • Etz C.D.
        • Homann T.
        • Silovitz D.
        • Bodian C.A.
        • Luehr M.
        • Di Luozzo G.
        • Plestis K.
        • Griepp R.B.
        Vascular graft replacement of the ascending and descending aorta: do dacron grafts grow?.
        Ann Thorac Surg. 2007; 84: 1206-1213
        • Skillington P.D.
        • Grigg L.E.
        Insertion of the pulmonary autograft as an inclusion cylinder – modifications to existing techniques.
        J Heart Valve Dis. 1995; 4: 374-378