NEW YORK — Observation is an acceptable alternative to surgical management of ascending aortic dilatation in adult patients with congenital heart disease, judging by a series of 81 patients with long-term follow-up.
The longstanding controversy among thoracic surgeons over the need to repair a dilated ascending aorta during aortic valve repair centers on how large the dilatation should be before starting a repair, and what types of patients should have the preventative operation, Dr. John M. Stulak said at the symposium sponsored by the American Association for Thoracic Surgery.
He and and his colleagues at the Mayo Clinic, Rochester, Minn., analyzed data on 81 patients aged 18–59 with congenital heart failure who were followed over 35 years; 53 had isolated aortic valve repair and 9 had combined valve and ascending root repair. Four patients in the series required reoperation during a median follow-up of 3.8 years.
After the initial operation, 96% of patients remained free from reoperation on the ascending aorta or aortic valve at 5 years and 90% at 8 years. Indications for reoperations were leakage of the prosthetic valve, severe aortic regurgitation after intensive aortic valve repair, and aortic root replacement caused by aneurysm.
“The moderately dilated aorta in the setting of a conotruncal abnormality, especially in patients undergoing isolated aortic valve replacement, may be observed,” said Dr. Stulak.
Disclosures: Dr. Stulak had no relevant conflicts.