Midterm outcomes of concomitant ascending aorta replacement with rapid deployment aortic valve replacement.

Background: Aortic valve replacement (AVR) frequently accompanies concomitant ascending aorta replacement. This study was conducted to evaluate the early and midterm outcomes of patients who underwent AVR with rapid-deployment valve (RDAVR) and concomitant ascending aorta replacement compared to those who underwent isolated RDAVR.

Methods: From June 2016 to June 2023, 130 patients who underwent RDAVR with concomitant ascending aorta replacement (Ao-AVR group) and 108 patients who underwent isolated RDAVR (Iso-AVR group) were enrolled in this study. Early and midterm outcomes were compared between the groups. Multivariate analysis was performed to identify the risk factors associated with all-cause mortality.

Results: Ao-AVR group was younger and less morbid than Iso-AVR group. Bicuspid aortic valvulopathy was the main etiology in Ao-AVR group (71.5%), whereas degenerative calcific valvulopathy was the main etiology in Iso-AVR group (55.6%). Cardiopulmonary bypass time and aortic cross-clamp time were 21 and 28 minutes longer, respectively, in Ao-AVR group. Operative mortality was 0.0% in Ao-AVR group, and their early clinical outcomes were comparable to those of Iso-AVR group, except for the occurrence of postoperative atrial fibrillation (46.9% vs. 34.3%, P=0.048). Multivariate analysis demonstrated that age, chronic obstructive pulmonary disease, and emergency operation were the significant risk factors associated with midterm all-cause mortality, whereas concomitant ascending aorta replacement was not a risk factor.

Conclusions: Concomitant ascending aorta replacement during RDAVR demonstrated excellent early and midterm outcomes, comparable to isolated RDAVR.