Aortic Valvular and Vascular Remodeling

Our study included a total of 25 BAV subjects (19 males and 6 females; mean age: 56.7 ± 13.5 years) and 35 TAV subjects (23 males and 12 females, mean age: 66.4 ± 7.1 years). They were randomly selected from patients undergone to surgery replacement or routine care screening in the Unit of Cardiac Surgery (Department of Surgery and Oncology, University of Palermo), by using apposite exclusion criteria for arteriosclerosis or other cardiovascular diseases, connective tissue disorders, and inflammatory diseases (from infections to hematological, gastrointestinal, urogenital, pulmonary, neurological, and endocrinal inflammatory disorders and neoplasia included). They were enrolled from January 2015 to December 2016. Furthermore, we selected BAV and TAV individuals with or without TAA, as a complication, for evaluating appropriate controls for the same groups. In addition, they belonged to the same ethnic group, since their parents and grandparents were born in Western Sicily.
Elective or urgent surgical treatments (using Bentall-De Bono and Tirone David surgical techniques, whenever possible) with complementary tubular-ascending aorta resection were performed in both BAV and TAV patients with TAA after the evaluation of aortic transverse diameter sizes. The evaluation of aorta diameters was done preoperatively as well as in the operating theatre performed by an experienced physician by transesophageal echocardiography (Philips Ie. 33) before the institution of the cardiopulmonary bypass. The dimension of the aortic annulus, sinuses of Valsalva, proximal ascending aorta (above 2.5 cm of the sinotubular junction), and aortic arch are assessed and presented in Table 1.
Demographic and clinical data, including comorbidities, were obtained from patients' medical records (Table 1). In all BAV and TAV cases, hypertension was treated by using beta-blockers.
Blood samples were collected into EDTA-coated tubes from all individuals enrolled and at the moment of their admission in the Unit of Cardiac Surgery. They were transported to the laboratory and processed within 1 to 2 hours after the collection.