The Impact of Bicuspid Aortic Valve Leaflet Fusion Morphology on the Ascending Aorta and on Outcomes of Aortic Valve Replacement.

BACKGROUND: Patients with bicuspid aortic valves (BAVs) tend to develop dilation of the ascending aorta. The aim of this study was to analyze the impact of leaflet fusion pattern on aortic root diameter and outcomes in patients undergoing surgery for BAV vs tricuspid aortic valve (TAV) disease. METHODS: This is a retrospective review of 90 patients with aortic valve disease (mean [SD] age, 51.5 [8.2] years) who underwent aortic valve replacement for BAV (n = 60) and TAV (n = 30). Fusion of right-left (R/L) coronary cusps was identified in 45 patients, whereas the remaining 15 patients had right-noncoronary (R/N) cusp fusion. Aortic diameter was measured at 4 levels, and Z values were computed. RESULTS: There were no significant differences between the BAV and TAV groups for age, weight, aortic insufficiency grade, or size of implanted prostheses. However, a higher preoperative peak gradient at the aortic valve was significantly associated with R/L fusion (P = .02). Preoperative Z values of ascending aorta and sinotubular junction diameter were significantly higher in patients with R/N fusion than with the R/L (P < .001 and P = .04, respectively) and TAV (P < .001 and P < .05, respectively) subgroups. During the follow-up period (mean [SD], 2.7 [1.8] years), 3 patients underwent a redo procedure. At the last follow-up, the sizes of ascending aorta were similar among all 3 patient groups. CONCLUSION: This study suggests that preoperative dilation of the ascending aorta is more common in patients with R/N fusion than in patients with R/L and TAV but is not significantly different between all groups in the early follow-up period. R/L fusion was associated with an increased risk of preoperative presence of aortic stenosis.

Gastrointestinal complications following cardiac surgery: a comprehensive review.

INTRODUCTION: Gastrointestinal (GI) complications following cardiac surgery are associated with a high morbidity and mortality, prolonged hospital stay and increased cost of hospitalization. METHODS: A literature search was carried out using Medline for articles published in the past 30 years. Prospective and retrospective papers that dealt with coronary artery bypass grafting (CABG), CABG/valve operations were selected and those that dealt with thoracic and transplant complications were excluded. RESULTS: We reviewed 151,652 patients reported over the past 30 years; GI complications occurred on average after 1.21% of cardiac operations and had an associated mortality of 34.1%. The most common risk factors identified include age greater than 70 years, low cardiac output, peripheral vascular disease, reoperative surgery, chronic renal insufficiency, increased number of blood transfusions, prolonged cardiopulmonary bypass time, arrhythmias, and use of an intraaortic balloon pump. A critical examination of the available literature revealed multifactorial etiologies (often related to hypoperfusion) leading to GI complications. Delayed diagnosis was associated with poor outcomes. CONCLUSION: GI complications are rare events, but early diagnosis is essential. Unfortunately few of the risk factors we have defined are specific and are often indicators of ill patients. A low threshold to initiate laboratory evaluation and/or imaging studies should be employed if a patient shows signs of deviating from the normal course following cardiac surgery.