Bad Mad
Well-known member
I came across this interesting article, which talks about the relationship between AVR and Aortic Dissection. One of the authors performed my homgraft AVR in 2001. He takes a specific interest in Aortic valve operations.
Aortic valve replacement has been identified as an independent risk factor for type 1 aortic dissection with 0.6% of patients developing dissection following AVR [1]. In a retrospective analysis of 119 patients with Type A dissection following AVR, von Kodolitsch et al. [1] identified the presence of aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation to be predictive of subsequent dissection. This suggests the presumed mechanism(s) relates to the development of an at-risk susceptible aorta as a consequence of either intrinsic aortic wall pathology or turbulent flow in the proximal aorta associated with the native valve lesion or a combination of both. In their report, cystic median necrosis was present in only 37% of patients and not predictive of subsequent dissection.
In general, there appears to be no relationship between prosthetic type (mechanical versus biological or mechanical design) and the risk of subsequent dissection [1]. However, the majority of reported cases in literature are associated with mechanical aortic prostheses, although this may simply reflect more frequent usage of the mechanical type.
http://icvts.ctsnetjournals.org/cgi/content/full/2/4/450
Aortic valve replacement has been identified as an independent risk factor for type 1 aortic dissection with 0.6% of patients developing dissection following AVR [1]. In a retrospective analysis of 119 patients with Type A dissection following AVR, von Kodolitsch et al. [1] identified the presence of aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation to be predictive of subsequent dissection. This suggests the presumed mechanism(s) relates to the development of an at-risk susceptible aorta as a consequence of either intrinsic aortic wall pathology or turbulent flow in the proximal aorta associated with the native valve lesion or a combination of both. In their report, cystic median necrosis was present in only 37% of patients and not predictive of subsequent dissection.
In general, there appears to be no relationship between prosthetic type (mechanical versus biological or mechanical design) and the risk of subsequent dissection [1]. However, the majority of reported cases in literature are associated with mechanical aortic prostheses, although this may simply reflect more frequent usage of the mechanical type.
http://icvts.ctsnetjournals.org/cgi/content/full/2/4/450
