• Chan B Park, Kevin L Greason, Rakesh M Suri, Hector I Michelena, Hartzell V Schaff, and Thoralf M Sundt.
• Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
• J. Thorac. Cardiovasc. Surg. 2011 Sep 1;142(3):602-7.

ObjectivesBicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting.MethodsWe identified patients with bicuspid aortic valve undergoing repair or replacement of the ascending aorta with or without aortic valve replacement or root replacement between January 1988 and December 2007 at our institution. Follow-up was by review of clinical records and postal questionnaire.ResultsOf 470 patients identified, 48 patients had hemiarch or total arch replacement and were excluded. Of the remaining 422 patients, 227 had separate aortic valve replacement or repair and ascending aortoplasty (76) or ascending aortic graft replacement (175), 107 a valved conduit, 40 a homograft root, and 21 a valve-sparing root replacement. The mean age was 56 ± 15 years, and 80% were male. Follow-up was up to 17 (median 4.2) years. There were 23 (5.5%) late reoperations, of which none were for arch dilatation. Survival at 1, 5, 10, and 12 years was 96.5%, 89.6%, 77.7%, and 74.0%. Freedom from late reoperation was 98.7%, 94.1%, 81.0%, and 81.0%. Paired echocardiographic measurements of aortic arch diameter (n = 58) were 33.3 mm preoperatively versus 31.9 mm postoperatively (P = .135) at a mean 4 years.ConclusionsProgressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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