Ascending Aortic Progression After Isolated Aortic Valve Replacement Among Patients with Bicuspid and Tricuspid Aortic Valves

TL;DR

This study found that patients with bicuspid and tricuspid aortic valves have similar long-term outcomes after aortic valve replacement, including survival and risk of aortic complications.

Contribution

The study demonstrates that bicuspid aortic valve is not a risk factor for adverse aortic events after isolated aortic valve replacement.

Findings

BAV and TAV patients had similar ascending aortic dilation rates and freedom from adverse aortic events.

Preoperative ascending aorta diameter was a significant predictor of adverse aortic events.

Long-term survival differences between BAV and TAV groups disappeared after adjusting for age.

Abstract

The aims of the present study were to compare the long-term outcomes for
ascending aortic dilatation and adverse aortic events after isolated aortic
valve replacement between patients with bicuspid aortic valve (BAV) and
tricuspid aortic valve ( TAV).

This retrospective study included 310 patients who had undergone isolated
aortic valve replacement with an ascending aorta diameter ≤ 45 mm
between January 2010 and September 2021. The patients were divided into BAV
group (n=90) and TAV group (n=220). The differences in the dilation rate of
the ascending aorta and long-term outcomes were analyzed.

Overall survival was 89 ± 4% in the BAV group vs. 75
± 6% in the TAV group at 10 years postoperatively
(P=0.007), yet this difference disappeared after adjusting
exclusively for age (P=0.343). The mean annual growth rate
of the ascending aorta was similar between the two groups during follow-up
(0.5 ± 0.6 mm/year vs. 0.4 ± 0.5 mm/year;
P=0.498). Ten-year freedom from adverse aortic events
was 98.1% in the BAV group vs. 95.0% in the TAV group
(P=0.636). Multivariable analysis revealed preoperative
ascending aorta diameter to be a significant predictor of adverse aortic
events (hazard ratio: 1.76; 95% confidence interval: 1.33 to 2.38;
P<0.001).

Our study revealed that the long-term survival and the risks of adverse
aortic events between BAV and TAV patients were similar after isolated
aortic valve replacement. BAV was not a risk factor of adverse aortic
events.

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