Key result
Aortic root replacement shows similar long-term mortality to isolated aortic valve replacement in bicuspid dysfunction.
Why the study?
Patients with bicuspid aortic valve have an increased risk of ascending aortic aneurysm, prompting consideration of lower surgical thresholds, but outcomes comparing isolated aortic valve replacement to aortic root replacement were needed.
Does aortic root replacement maintain comparable survival rates to isolated aortic valve replacement in adult patients with bicuspid aortic valve dysfunction?
Cohort (n=281)
No
Does aortic root replacement maintain comparable survival rates to isolated aortic valve replacement in adult patients with bicuspid aortic valve dysfunction?
Effect estimate: OR 0.91 (95% CI 0.40-2.06)
Absolute Event Rate: 8.1% vs 9.1%
p-value: p=0.814
Aortic root replacement in bicuspid aortic valve patients yields similar long-term survival to isolated aortic valve replacement, suggesting that prophylactic root replacement is a safe strategy to prevent future aortopathy complications.
Supports considering root replacement in bicuspid aortopathy; extends observational data but leaves randomized confirmation open.
BACKGROUND: Patients with a bicuspid aortic valve carry an increased risk for developing an ascending aortic aneurysm due to intrinsic aortic wall alterations. A lower threshold for aortic surgery may therefore be considered in these patients, especially in those who require aortic valve surgery. This study aimed to compare the outcomes of an isolated aortic valve replacement with that of an aortic root replacement in bicuspid aortic valve patients with an indication for aortic valve surgery. METHODS: Patients were included in retrospect from a tertiary academic hospital. Included patients received an elective aortic valve (AVR) or a composite valve-graft conduit (both mechanical and biological) between 2006 and 2021 without any concomitant procedure. Mortality data were retrieved from a national database and comparisons, including survival analyses, were performed between both groups. RESULTS: A total of 132 isolated AVR and 149 aortic root replacements were included. Patients who received an isolated AVR were significantly older than the aortic root replacement group (62.9 vs. 57.7 year respectively, p < 0.001). Survival analyses showed a comparable long-term mortality between both groups (8.1% vs. 9.1%, p = 0.321). CONCLUSION: This study shows that performing an aortic root replacement with a composite valve-graft conduit in bicuspid aortic valve patients does not impair the survival outcomes. In the light of preventing potential future aortic complications within this patient group with a congenitally and structurally weakened aortic wall, a more aggressive approach towards the treatment of BAV aortopathy might be considered.
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Dolmaci et al. (2024) conducted a cohort in Bicuspid aortic valve dysfunction (n=281). Aortic root replacement vs. Isolated aortic valve replacement was evaluated on Long-term (10-year) mortality (OR 0.91, 95% CI 0.40-2.06, p=0.814). Aortic root replacement in patients with bicuspid aortic valve dysfunction resulted in comparable long-term mortality to isolated aortic valve replacement (8.1% vs 9.1%, p=0.321).
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