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Outcomes After Isolated Aortic Valve Replacement in Patients with Bicuspid vs Tricuspid Aortic Valve

  • Jing Sun
    Affiliations
    Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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  • Sipeng Chen
    Affiliations
    Information Center, Biostatistical Unit, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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  • Cheng Sun
    Affiliations
    Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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  • Hongxia Qi
    Affiliations
    Department of Medical Imaging, Ultrasound Division, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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  • Xiangyang Qian
    Affiliations
    Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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  • Zhe Zheng
    Correspondence
    Address reprint requests to Zhe Zheng, Department of Cardiovascular Surgery, Fuwai Hospital, Beilishi Road No.167, Xicheng District, Beijing 100037, People's Republic of China. Telephone number: +86 13910698957.
    Affiliations
    Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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      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

      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)
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      References

        • Hoffman JI
        • Kaplan S.
        The incidence of congenital heart disease.
        J Am Coll Cardiol. 2002; 39: 1890-1900
        • Verma S
        • Siu SC.
        Aortic dilatation in patients with bicuspid aortic valve.
        N Engl J Med. 2014; 370: 1920-1929
        • Hardikar AA
        • Marwick TH.
        The natural history of guidelines: the case of aortopathy related to bicuspid aortic valves.
        Int J Cardiol. 2015; 199: 150-153
        • Borger MA
        • Fedak PWM
        • Stephens EH
        • Gleason TG
        • Girdauskas E
        • Ikonomidis JS
        • et al.
        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
        • Nissen AP
        • Truong VTT
        • Alhafez BA
        • Puthumana JJ
        • Estrera AL
        • Body SC
        • et al.
        Surgical Repair of Bicuspid Aortopathy at Small Diameters: Clinical and Institutional Factors.
        J Thorac Cardiovasc Surg. 2020; 159 (e2): 2216-2226
        • Sievers HH
        • Schmidtke C.
        A classification system for the bicuspid aortic valve from 304 surgical specimens.
        J Thorac Cardiovasc Surg. 2007; 133: 1226-1233
        • Debiec R
        • Sall H
        • Samani NJ
        • Bolger A.
        Genetic Insights Into Bicuspid Aortic Valve Disease.
        Cardiol Rev. 2017; 25: 158-164
        • Manka R
        • Binter C
        • Kozerke S.
        Hurricane aorta.
        Lancet. 2014; 384: 2141
        • Edlin J
        • Youssefi P
        • Bilkhu R
        • Figueroa CA
        • Morgan R
        • Nowell J
        • et al.
        Haemodynamic assessment of bicuspid aortic valve aortopathy: a systematic review of the current literature.
        Eur J Cardiothorac Surg. 2019; 55: 610-617
        • Borger MA
        • Preston M
        • Ivanov J
        • Fedak PW
        • Davierwala P
        • Armstrong S
        • et al.
        Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?.
        J Thorac Cardiovasc Surg. 2004; 128: 677-683
        • McKellar SH
        • Michelena HI
        • Li Z
        • Schaff HV
        • Sundt 3rd, TM
        Aortic Events Following Aortic Valve Replacement in Patients with Bicuspid Aortic Valves.
        Am J Cardiol. 2010; 106: 1626-1633
        • Hardikar AA
        • Marwick TH.
        Surgical thresholds for bicuspid aortic valve associated aortopathy.
        JACC Cardiovasc Imaging. 2013; 6: 1311-1320
        • Itagaki S
        • Chikwe JP
        • Chiang YP
        • Egorova NN
        • Adams DH.
        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
        • Russo CF
        • Mazzetti S
        • Garatti A
        • Ribera E
        • Milazzo A
        • Bruschi G
        • et al.
        Aortic complications after bicuspid aortic valve replacement: long-term results.
        Ann Thorac Surg. 2002; 74: S1773-S1776
        • Yasuda H
        • Nakatani S
        • Stugaard M
        • Tsujita-Kuroda Y
        • Bando K
        • Kobayashi J
        • et al.
        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
        • Girdauskas E
        • Disha K
        • Borger MA
        • Kuntze T.
        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
        • Wang Y
        • Wu B
        • Li J
        • Dong L
        • Wang C
        • Shu X.
        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
        • Chiang YP
        • Chikwe J
        • Moskowitz AJ
        • Itagaki S
        • Adams DH
        • Egorova NN.
        Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years.
        JAMA. 2014; 312: 1323-1329
        • von Kodolitsch Y
        • Loose R
        • Ostermeyer J
        • Aydin A
        • Koschyk DH
        • Haverich A
        • et al.
        Proximal aortic dissection late after aortic valve surgery: 119 cases of a distinct clinical entity.
        Thorac Cardiovasc Surg. 2000; 48: 342-346
        • Hagan PG
        • Nienaber CA
        • Isselbacher EM
        • Bruckman D
        • Karavite DJ
        • Russman PL
        • et al.
        The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.
        JAMA. 2000; 283: 897-903

      Linked Article

      • Commentary: What Happens to the Aorta in Bicuspid Aortic Valve Disease?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          Bicuspid 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
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      • Commentary: Can Patients with Bicuspid Aortopathy Be Ultimately Cured?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          In 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
        • PDF