Phenotypes of aortic valve disease according to detailed anatomical classification of patients who underwent aortic valve replacement surgery.

Abstract

The anatomy of the aortic valves plays an important role in the progression of aortic valve disease (AVD) and determination of the appropriate treatment strategy. We described and compared AVD phenotypes according to detailed anatomical classifications and assessed the accuracy of imaging diagnostics using surgical diagnosis as the gold standard. The study enrolled 602 patients (mean age 55.5±12.9 years; 74.1% male) who underwent their first aortic valve replacement surgery between June 2017 and March 2018 at Fuwai Hospital in Beijing, China. Clinical characteristics, histopathological diagnoses, preoperative transthoracic echocardiography (TTE), and other available imaging data were collected retrospectively from medical records. During surgery, 370 patients were diagnosed with a tricuspid aortic valve (TAV), 228 with a bicuspid aortic valve (BAV), and 4 with a quadricuspid aortic valve (QAV). The primary histopathological finding was myxomatous degeneration (48.4%) for those with TAV and fibrocalcification (57.9%) for those with BAV. Nearly all TAV patients (96.2%) had aortic regurgitation, while the majority of BAV patients had aortic stenosis (73.7%); the severity of stenosis and regurgitation varied across the subtypes of BAV. The overall diagnostic accuracy of preoperative TTE for aortic valve anatomy was 85.5%; accuracy was higher for TAV versus BAV (96.8% vs. 68.0%, P<.001). We identified different phenotypes of AVD among patients with different detailed anatomical classifications. In addition, the diagnostic accuracy of preoperative TTE for BAV was suboptimal, and more attention is needed to ensure an accurate anatomic diagnosis prior to surgical intervention.