Puzzling the ascending aortic aneurysm Pieces towards a better outcome in patients with thoracic aortic diseases

The thesis studied several aspects of the natural history and the treatment of ascending aortic aneurysms, including bicuspid aortic valve (BAV) disease, by means of literature and observational studies.
Among 560 patients under follow-up after aortic valve replacement in a non-academic teaching hospital, knowledge of native valve anatomy was analysed: in 32% this information was lacking, which withheld cardiologists from appropriate ascending aorta surveillance and initiation of family screening in BAV.
Among 446 patients with a surgeon’s description of native valve anatomy, 31% had a BAV. Compared to patients with a tricuspid aortic valve (TAV), and adjusted for age at surgery, gender, and years since surgery, BAV patients had less often preoperative hypercholesterolemia (p=0.001) and underwent less often concomitant coronary artery bypass grafting (adjusted odds ratio [adj.OR] 0.45;95%CI:0.25-0.83). On the contrary, surgery of the proximal aorta was performed more often (adj.OR 2.3;95%CI:1.3-4.0). The results indicate that an atherosclerotic pathophysiology has a more prominent role in the TAV valvulopathy process while this is less dominant in BAV.
In the same hospital-setting, the yield of family screening was evaluated in patients with isolated BAV. In a population of 134 screened first-degree relatives of 54 adult index patients, we diagnosed 13% new cases with BAV or ascending aortic dilatation without BAV. These data support the guideline recommendation for family screening also in general hospitals.
The literature was reviewed on isolated non-infectious ascending aortitis causing ascending aortic aneurysms. Due to its subclinical nature, isolated non-infectious ascending aortitis was usually an unexpected diagnosis at histopathologic review of resected tissue of an ascending aortic aneurysm. Therefore, it should be included in the differential diagnosis in patients with ascending aortic aneurysm.