Prophylactic replacement of a dilated ascending aorta at the time of aortic valve replacement of a dysfunctioning congenitally unicuspid or bicuspid aortic valve.

摘要

Recently, I examined a beautifully excised severely ste-notic congenitally bicuspid aortic valve in a 64-year-old man who, at the same operation, had undergone excision of the ascending aorta, which, by preoperative imaging studies, had a maximal diameter of 4.3 cm. Histologically, the wall of the aorta was normal. Although the aortic valve replacement (AVR) was clearly appropriate, was excision of the ascending aorta justified on a prophylactic basis? I would argue that the latter should be reconsidered. Before the 1990s, relatively few patients with stenotic or purely regurgitant congenitally malformed aortic valves also underwent concomitant resection of the dilated ascending aorta. During the 1990s, some prominent and persuasive cardiac surgeons began advocating prophylactic concomitant ascending aortic resection in these circumstances, mainly for 3 reasons.