JUAN CRESTANELLO: Welcome to the cardiovascular surgery series where we review the latest research in cardiovascular surgery from the Mayo Clinic in just two minutes. I am Dr. Juan Crestanello, and I am a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota.

We will discuss today the natural history and outcomes of nonreplaced aortic sinuses in patients with bicuspid aortic valve. This article was published in the Annals of Thoracic Surgery in February 2022. In this study, 400 patients with bicuspid aortic valve who had aortic valve replacement and ascending aorta replacement were studied.

In all of those patients, the sinus of valsalva were left intact. Patients were stratified by the size of the sinus of valsalva at the original operation in those who had sinus of valsalva smaller or larger than 40 millimeters. After a median follow up of 8.1 years, the sinus of valsalva diameter was not associated with the outcomes.

Patients with sinus of valsalva diameter smaller or larger than 40 millimeters had a similar survival and similar rate of reoperation, which was less than 10% at 15 years for both groups. In terms of the progression in size of the sinus of valsalva, patients with the smaller or larger sinus of valsalva had a gradual dilatation late in the period of the study.

We conclude that the sinus of valsalva enlarged slowly after aortic valve replacement and ascending aorta replacement. The sinus of valsalva diameter was not a risk factor for survival or reoperation. Longer follow up is needed to address the fate of nonreplaced sinus of valsalva in younger patients with longer life expectancy. Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.