Key result
Bicuspid aortic valve linked to ~55% lower coronary sclerosis score versus tricuspid valve in AS.
Why the study?
While AoS in tricuspid aortic valve strongly associates with CAD, it remains unclear whether AoS in patients with bicuspid aortic valve is also associated with CAD.
Does bicuspid aortic valve morphology associate with a lower extent of coronary artery disease compared to tricuspid aortic valve morphology in patients undergoing aortic valve replacement for aortic stenosis?
Observational (n=1,296)
No
Does bicuspid aortic valve morphology associate with a lower extent of coronary artery disease compared to tricuspid aortic valve morphology in patients undergoing aortic valve replacement for aortic stenosis?
Absolute Event Rate: 1.61% vs 3.6%
p-value: p=<0.001
Patients with bicuspid aortic valve undergoing surgery for aortic stenosis have significantly less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared to those with tricuspid aortic valve.
BAV morphology was associated with less coronary sclerosis in AS surgery; leaves open whether valve type independently influences CAD risk and requires prospective confirmation.
Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, which is often complicated by aortic valve stenosis (AoS). In tricuspid aortic valve (TAV), AoS strongly associates with coronary artery disease (CAD) with common pathophysiological factors. Yet, it remains unclear whether AoS in patients with BAV is also associated with CAD. This study investigated the association between the aortic valve morphological features and the extent of CAD. Methods and Results A single‐center study was performed, including all patients who underwent an aortic valve replacement attributable to AoS between 2006 and 2019. Coronary sclerosis was graded on preoperative coronary angiographies using the coronary artery greater even than scoring method, which divides the coronaries in 28 segments and scores nonobstructive (20%–49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Multivariate analyses were performed, controlling for age, sex, and CAD risk factors. A total of 1296 patients (931 TAV and 365 BAV) were included, resulting in 548 matched patients. Patients with TAV exhibited more CAD risk factors (odds ratio [OR], 2.66; 95% CI, 1.79–3.96; P <0.001). Patients with BAV had lower coronary artery greater even than 20 (1.61±2.35 versus 3.60±2.79) and coronary artery greater even than 50 (1.24±2.43 versus 3.37±3.49) scores ( P <0.001), even after correcting for CAD risk factors ( P <0.001). Patients with TAV more often needed concomitant coronary revascularization (OR, 3.50; 95% CI, 2.42–5.06; P <0.001). Conclusions Patients with BAV who are undergoing surgery for AoS carry a lower cardiovascular risk profile, correlating with less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared with patients with TAV.
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Dolmaci et al. (2021) conducted an observational in Aortic valve stenosis (n=1,296). Bicuspid aortic valve vs. Tricuspid aortic valve was evaluated on Extent of coronary artery disease (CAGE≥20 score) (p=<0.001). Patients with bicuspid aortic valves undergoing surgery for aortic stenosis had significantly lower coronary sclerosis scores (1.61 vs 3.60, P<0.001) compared to patients with tricuspid valves.
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