To compare the outcomes in patients undergoing isolated aortic valve replacement with
bicuspid (BAV) vs tricuspid aortic valves (TAV). A total of 1204 consecutive patients
(BAV, n = 454; TAV, n = 750) underwent isolated aortic valve replacement (AVR) between 2002 and 2009 at
a single institution. Adverse aortic events were defined as the occurrence of aortic
dissection or the ascending aorta diameter greater than 50 mm or sudden death during
follow-up. Propensity score matching yielded 318 patient pairs. Follow-up was obtained
on 1156 patients. The mean length of follow up was 10.4 ± 3.9 years. A total of 155
(13.4%) patients died, and adverse aortic events occurred in 44 (3.8%) patients. After
propensity score matching, the 12-year survivals was 85.5% in the BAV group and 89.2%
in the TAV group; hazard ratio (HR) 1.6; 95% confidence interval (CI) 1.0-2.5; P = 0.057. The 12-year cumulative incidence of late adverse aortic events was 14.6%
in the BAV group and 10.8% in the TAV group; subdistribution hazard ratio (sHR) 1.1;
95% CI 0.6-2.0; P = 0.758. In the isolated aortic regurgitation subgroup, the rate of adverse aortic
events was significantly higher in the BAV group than in the TAV group (sHR, 2.1;
95% CI, 1.1-4.0; P = 0.021). The long-term survival after isolated AVR was similar in both BAV and TAV
patients. BAV does not increase the adverse aortic events after isolated AVR compared
with the TAV.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
BAV (bicuspid aortic valve), TAV (tricuspid aortic valve), AVR (aortic valve replacement), AS (aortic stenosis), AI (aortic insufficiency), AATS (American Association for Thoracic Surgery), CT (computed tomography), MRI (magnetic resonance imaging), HR (hazard ratio), CI (confidence interval), sHR (subdistribution hazard ratio)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seminars in Thoracic and Cardiovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The incidence of congenital heart disease.J Am Coll Cardiol. 2002; 39: 1890-1900
- Aortic dilatation in patients with bicuspid aortic valve.N Engl J Med. 2014; 370: 1920-1929
- The natural history of guidelines: the case of aortopathy related to bicuspid aortic valves.Int J Cardiol. 2015; 199: 150-153
- The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version.J Thorac Cardiovasc Surg. 2018; 156: e41-e74
- Surgical Repair of Bicuspid Aortopathy at Small Diameters: Clinical and Institutional Factors.J Thorac Cardiovasc Surg. 2020; 159 (e2): 2216-2226
- A classification system for the bicuspid aortic valve from 304 surgical specimens.J Thorac Cardiovasc Surg. 2007; 133: 1226-1233
- Genetic Insights Into Bicuspid Aortic Valve Disease.Cardiol Rev. 2017; 25: 158-164
- Hurricane aorta.Lancet. 2014; 384: 2141
- Haemodynamic assessment of bicuspid aortic valve aortopathy: a systematic review of the current literature.Eur J Cardiothorac Surg. 2019; 55: 610-617
- Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?.J Thorac Cardiovasc Surg. 2004; 128: 677-683
- Aortic Events Following Aortic Valve Replacement in Patients with Bicuspid Aortic Valves.Am J Cardiol. 2010; 106: 1626-1633
- Surgical thresholds for bicuspid aortic valve associated aortopathy.JACC Cardiovasc Imaging. 2013; 6: 1311-1320
- Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients with Bicuspid Aortic Valve Vs Marfan Syndrome.J Am Coll Cardiol. 2015; 65: 2363-2369
- Aortic complications after bicuspid aortic valve replacement: long-term results.Ann Thorac Surg. 2002; 74: S1773-S1776
- Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve.Circulation. 2003; : II291-II294
- Long-term prognosis of ascending aortic aneurysm after aortic valve replacement for bicuspid vs tricuspid aortic valve stenosis.J Thorac Cardiovasc Surg. 2014; 147: 276-282
- Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients with a Bicuspid Aortic Valve.Ann Thorac Surg. 2016; 101: 1707-1714
- Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years.JAMA. 2014; 312: 1323-1329
- Proximal aortic dissection late after aortic valve surgery: 119 cases of a distinct clinical entity.Thorac Cardiovasc Surg. 2000; 48: 342-346
- The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.JAMA. 2000; 283: 897-903
Article info
Publication history
Published online: August 08, 2021
Footnotes
Date and number of IRB approval: 3/2013, 2012-404 and 11/2020, 2020-1281. The Institutional Review Board (IRB) of the Fuwai Hospital approved the study protocol and publication of data. Patient written consent for the publication of the study data was waived by the IRB for the patients provided oral consent during telephone interview.
This manuscript is not an AATS Meeting Presentation or WTSA Meeting Presentation.
Funding: The National Key Research and Development Program of China (Project No. 2016YFC1302000) supported this study.
Conflicts of Interest: There are no interest declarations.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: What Happens to the Aorta in Bicuspid Aortic Valve Disease?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewBicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is characterized by genetic and hemodynamic factors that predispose affected individuals to aortic valve disease and aortopathies.1 Over half of patients with BAV will develop significant valvular dysfunction within 25 years of their initial diagnosis, for which the primary treatment is aortic valve replacement (AVR) for non-repairable valves.2 The past decade has brought forth significant changes to bicuspid AVR, with a shift towards concomitant aortic surgery.
- Full-Text
- Preview
- Commentary: Can Patients with Bicuspid Aortopathy Be Ultimately Cured?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewIn this issue of Seminars, Sun et al.1 analyzed mortality and late aortic adverse events in 1204 patients with bicuspid (n=454) versus tricuspid (n=750) aortic valves after isolated aortic valve replacement (AVR) at a single center in Beijing, China, between 2002 and 2009. The authors used propensity score matching and included 318 propensity score-matched patient-pairs. During a mean follow-up of ten years, the authors found no difference in mortality or aortic adverse events between the two groups.
- Full-Text
- Preview
