Abstract
Objective: We sought to evaluate the outcomes of integrated aortic-valve and ascending-aortic replacement (IR) vs. partial replacement (PR) in patients with bicuspid aortic valve (BAV)-related aortopathy.Methods: We compared long-term mortality, reoperation incidence, and the cumulative incidence of stroke, bleeding, significant native valve or prosthetic valve dysfunction, and the New York Heart Association (NYHA) functional classes II-IV between inverse probability-weighted cohorts of patients who underwent IR or PR for BAV-related aortopathy in a single center from 2002 to 2019. Patients were stratified into different aortic diameter groups (“valve type” vs. “aorta type”).Results: Among patients with “valve type,” aortic valve replacement in patients with an aortic diameter > 40 mm was associated with significantly higher 10-year mortality than IR compared with diameter 35–40 mm [17.49 vs. 5.28% at 10 years; hazard ratio (HR), 3.22; 95% CI, 1.52 to 6.85; p = 0.002]. Among patients with “aorta type,” ascending aortic replacement in patients with an aortic diameter 52–60 mm was associated with significantly higher 10-year mortality than IR compared with diameter 45–52 mm (14.49 vs. 1.85% at 10 years; HR, 0.04; 95% CI, 1.06 to 85.24; p = 0.03).Conclusion: The long-term mortality and reoperation benefit that were associated with IR, as compared with PR, minimizing to 40 mm of the aortic diameter among patients with “valve type” and minimizing to 52 mm of the aortic diameter among patients with “aorta type.”Trial Registration: Treatment to Bicuspid Aortic Valve Related Aortopathy (BAVAo Registry): ChiCTR.org.cn no: ChiCTR2000039867.
Highlights
Bicuspid aortic valve (BAV) disease is the most common congenital cardiac disorder, being present in 1–2% of the general population (1)
Among patients with “valve type,” aortic valve replacement in patients with an aortic diameter > 40 mm was associated with significantly higher 10-year mortality than integrated aortic-valve-andascending-aortic replacement (IR) compared with diameter [35–40] mm [17.49 vs. 5.28% at 10 years; hazard ratio (HR), 3.22; 95% CI, 1.52 to 6.85; p = 0.002]
Among patients with “aorta type,” ascending aortic replacement in patients with an aortic diameter [52–60] mm was associated with significantly higher 10-year mortality than IR compared with diameter [45–52] mm (14.49 vs. 1.85% at 10 years; HR, 0.04; 95% CI, 1.06 to 85.24; p = 0.03)
Summary
Bicuspid aortic valve (BAV) disease is the most common congenital cardiac disorder, being present in 1–2% of the general population (1). Associated aortopathy, the dilatation of the aortic sinuses, and ascending aorta are present in ∼20–40% of patients with BAV (2). Evidence supporting treatment of BAV and aortopathy as separate entity has increased, data on the combined (valve and aorta) pathological phenotypes remain scarce. A comprehensive understanding of the interaction between morphologic features and functional characteristics of the BAV and aortopathy along with transvalvular hemodynamics is required. Among patients with BAV with significant valve dysfunction, the practice guideline recommended cutoff for concomitant ascending aortic replacement is 45 mm (7, 8). There is a lack of evidence to clarify the need for concomitant aortic valve replacement among patients with dilated aorta, but without significant BAV dysfunction. As etiologic hypotheses based on the phenotypic heterogeneity of BAV and aortopathy continue to be discussed, specific surgical approaches and timing may be required. The aim of this study was to compare the perioperative and follow-up benefits and risks of integrated aortic-valve-andascending-aortic replacement (IR) vs. partial replacement (PR) for BAV-related aortopathy
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