Alexander R. Opotowsky, MD, MPH, Todd Perlstein, MD, Michael J

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Presentation transcript:

A shifting approach to management of the thoracic aorta in bicuspid aortic valve Alexander R. Opotowsky, MD, MPH, Todd Perlstein, MD, Michael J. Landzberg, MD, Steven D. Colan, MD, Patrick T. O’Gara, MD, Simon C. Body, MBChB, MPH, Liam F. Ryan, MD, Sary Aranki, MD, Michael N. Singh, MD The Journal of Thoracic and Cardiovascular Surgery Volume 146, Issue 2, Pages 339-346 (August 2013) DOI: 10.1016/j.jtcvs.2012.10.028 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The number of surgical procedures performed in patients with BAV in the United States from 1998 to 2009, stratified by procedure type. There was an increase in the overall number of AVR and TAS among patients with BAV in the United States over time. This increase was most marked for patients undergoing AVR and concomitant TAS. AVR, Aortic valve repair or replacement; TAS, thoracic aortic surgery; BAV, bicuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 339-346DOI: (10.1016/j.jtcvs.2012.10.028) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Temporal trend in the proportion of hospitalizations in which patients with BAV receiving AVR underwent concomitant TAS (% ± standard error %), 1998-2009. The increase in aortic surgery was closely paralleled by an increase in diagnosis of TAA (dotted line). SE, Standard error. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 339-346DOI: (10.1016/j.jtcvs.2012.10.028) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Subgroup analysis of the proportion of patients undergoing AVR that included concomitant TAS for each time epoch. A, Patients aged less than 50 years or 50 or more years. A greater proportion of younger patients underwent aortic surgery, at an increasing frequency of the study duration. B, Gender. Men more frequently underwent aortic surgery, at an increasing frequency of the study duration. C, Type of hospital. Concomitant aortic surgery was performed more frequently at teaching hospitals, at an increasing frequency of the study duration. Nonteaching hospitals did not show a similar trend to perform concomitant aortic surgery over the study duration. There seemed to be a more consistent and prominent trend to a greater proportion of aortic surgeries in teaching hospitals. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 339-346DOI: (10.1016/j.jtcvs.2012.10.028) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 In-hospital mortality, by 2-year time period, for patients undergoing isolated AVR and patients undergoing concomitant TAS. There was a trend toward lower mortality over time for all groups. Data for isolated TAS are not shown because of the smaller number of cases/deaths, as well as distinct patient characteristics (ie, higher dissection and coarctation frequency). Error bars represent standard error %. AVR, Aortic valve replacement or repair; TAS, thoracic aortic surgery. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 339-346DOI: (10.1016/j.jtcvs.2012.10.028) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions