Abstract 20004: Long-term Risk of Mortality, Aortic Dissection and Thoracic Aortic Surgery After Isolated Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Valves

Abstract

Introduction: The natural history of aortopathy after isolated aortic valve replacement (AVR) in patients with bicuspid aortic valves (BAV) is not well characterized. Hypothesis: The incidence of dissection and thoracic aortic surgery after isolated AVR in patients with BAV is higher than in patients with tricuspid valves. Methods: From 1995-2010, 2,203 bicuspid and 1,436 rheumatic tricuspid patients undergoing isolated AVR were identified from the Statewide Planning and Research Cooperative System which captures all inpatient admissions and emergency visits to every hospital in New York State. Deaths were identified from the Social Security Death Master File. Kaplan-Meier analysis of survival and competing risk analysis of aortic dissection and thoracic aortic surgery was performed. Results: BAV patients were younger than tricuspid aortic valve (TAV) patients (52.0 vs. 64.2 years, p<0.001). Survival at 15 years after AVR was 77% versus 58%, respectively (p<0.001). During median follow up of 8.0 years (range 0-19.0 years), aortic dissection occurred in 9 BAV patients versus 4 TAV patients. The 15-year cumulative incidence of dissection after AVR in BAV patients was 0.7% versus 0.4% in TAV patients (p=0.28) (Figure 1). Thoracic aortic surgery was performed in 33 BAV patients versus 9 TAV patients. The 15-year cumulative incidence of thoracic aortic surgery was 3.1% in BAV patients versus 1.1% in TAV patients (p<0.001) (Figure 2). Conclusions: Patients undergoing isolated AVR of bicuspid valves are at greater long-term risk of aortic dissection and thoracic aortic surgery than patients with tricuspid valves, and should be considered for life-long surveillance.