Surgeries for Adults with Bicuspid Aortic Valve (BAV) in Adults with a Past History of Coarctation Repair–Differences from Isolated BAV Patients

Abstract

Background: While the co-existence of bicuspid aortic valves (BAV) and coarctation of the aorta (CoA) is well documented, the impact of previous CoA repair on surgical intervention for BAV has not been explored. Methods: We reviewed our tertiary referral centre databases for Adult Congenital Heart Disease and for Aortic Surgery. Survival data were obtained from the National Death Index. Patients were followed for 8.3 ± 10.2 years post-operatively. Results: Of 472 patients who had surgery for BAV, 24 (5%) had had prior successful CoA repair. Age at surgery for those with CoA was 39 ± 16 years compared to 59 ± 15 years for those with isolated BAV (p < 0.0001). 17 patients with CoA (71%) received mechanical aortic valve replacements (AVR) compared to163/448(36%) with isolated BAV (p < 0.0001). 4 received tissue AVR and 3 had a Ross procedure. 12 with CoA (50%) required aortic root replacement, compared to 164/448(37%)(p = 0.19). In 17 patients with CoA and 368 patients overall, the primary indication for surgery was assessable. Only 7 patients with CoA (29%) presented with aortic stenosis (±root dilatation), compared with 230/351 without CoA (p < 0.0001). Postoperative survival for the CoA patients was 100% at 1 month; 95% at 1 and 3 years; and 88% at 5 years after BAV surgery, similar to those operated for isolated BAV. Conclusions: Patients with a history of CoA who are operated on for BAV are younger and more likely to come to surgery for reasons other than progressive aortic stenosis. Medium term postoperative outcomes are excellent, in this group.