Abstract 9944: Bicuspid and Unicuspid Aortic Valve: Fate of Moderate/Severe Mixed Aortic Valve Disease

Abstract

Objectives: There is paucity of data about mixed aortic valve disease (MAVD) in patients with bicuspid/unicuspid aortic valve (BAV). This study sought to describe the natural history of moderate/severe MAVD in this population. Methods: We queried our database for patients with BAV and moderate/severe MAVD from 1994-2013. We excluded patients with NYHA III/IV symptoms, left ventricular ejection fraction <50%, aortic dimension >50 mm, and significant disease of other valves. Primary endpoint was freedom from adverse events (AE) defined as aortic valve replacement (AVR) or death. Secondary endpoint was freedom from developing NYHA III/IV symptoms, and to identify predictors of AE. Cox proportional hazard model was used. Results: There were 138 patients (age 51±12 years, males 81%) who were followed for 8.5±4 years. Ninety-two patients (67%) underwent AVR at a mean follow-up duration of 3.7±2.5 years. Mechanical prostheses were implanted in 79% and 52% had concomitant CABG and/or aortic replacement during AVR. No early surgical mortality. Event-free survival was 51%, and 20% at 5 and 10 years. Predictors of AE were age at presentation (hazard ratio [HR] 5.22 Confidence interval [CI] 3.10 to 6.64) for every decade increase in age and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16). Conclusion: Time (age and duration of follow-up) was the strongest predictor of AE in BAV population unlike in patients with trileaflet aortic valve stenosis where peak aortic velocity was prognostic. Figure Legend: pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation