Aortic wall thickness in dilated ascending aorta: Comparison between tricuspid and bicuspid aortic valve

Pasquale Totaro; Simone Morganti; Ferdinando Auricchio; Stefano Pelenghi

doi:10.1016/j.acvd.2023.08.003

Aortic wall thickness in dilated ascending aorta: Comparison between tricuspid and bicuspid aortic valve

Arch Cardiovasc Dis. 2023 Sep 14:S1875-2136(23)00167-5. doi: 10.1016/j.acvd.2023.08.003. Online ahead of print.

Authors

Pasquale Totaro¹, Simone Morganti², Ferdinando Auricchio³, Stefano Pelenghi⁴

Affiliations

¹ Division of Cardiac Surgery, IRCCS Foundation Hospital "San Matteo", Piazzale Golgi 1, 27100 Pavia, Italy. Electronic address: p.totaro@smatteo.pv.it.
² Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy.
³ Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy.
⁴ Division of Cardiac Surgery, IRCCS Foundation Hospital "San Matteo", Piazzale Golgi 1, 27100 Pavia, Italy.

PMID: 37770332
DOI: 10.1016/j.acvd.2023.08.003

Abstract

Background: Bicuspid aortic valve (BAV) is frequently associated with dilatation of the thoracic aorta. Peculiar anatomical, histological and mechanical changes of the aortic wall in BAV aortopathy have been hypothesized to suggest an increased risk of acute aortic complications in patients with BAV.

Aim: In this study we tried to clarify any differences in the adaptability of the aortic wall to the mechanism of dilatation between patients with BAV and those with TAV.

Methods: In total, 354 samples were taken from 71 patients undergoing elective aortic surgery and divided into two groups: BAV group (n=16; 101 samples); and TAV group (n=55; 253 samples). Aortic wall thickness was measured with a dedicated caliper. The relationship between aortic wall thickness and aortic dilatation and demographic variables was evaluated cumulatively and comparatively (BAV versus TAV). In patients with more than three samples available, intrapatient variability was also studied. Finally, potential risk factors for severely reduced aortic wall thickness were also assessed.

Results: Analysis of preoperative characteristics revealed significant differences in patient age (54±16years for BAV and 66±11years for TAV; P=0.0011), with no differences in variables related to aortic dilatation (including phenotype). Cumulative aortic wall thickness was significantly thinner in the anterior than in the posterior wall. In the comparative analysis, aortic wall thickness was significantly thinner in patients with BAV in both the anterior and posterior regions. Furthermore, in patients with BAV, dilatation>51mm was a significant predictor of severely reduced aortic wall thickness.

Conclusions: In our experience, patients with BAV aortopathy reached the cut-off for the surgical indication at an early age. Careful monitoring in patients with BAV is mandatory when aortic dilatation has reached 51mm, as it is related to significant anatomical changes.

Keywords: Ascending aorta aneurysm; Bicuspid aortic valve; Mechanical properties.