Key result
Adults with bicuspid aortic valve and prior coarctation repair underwent surgery at a younger age and more frequently for aortic regurgitation (38% vs 13%, p<0.001) than those without prior repair.
Why the study?
A small proportion of patients undergoing BAV intervention have had prior repair of aortic coarctation, but phenotypic differences between those with versus without prior repair were not well described.
Do clinical profiles and surgical indications differ between bicuspid aortic valve patients with versus without prior repaired aortic coarctation?
Cohort (n=556)
Do clinical profiles and surgical indications differ between bicuspid aortic valve patients with versus without prior repaired aortic coarctation?
Absolute Event Rate: 38% vs 13%
p-value: p=<0.001
Adult bicuspid aortic valve patients with a history of repaired aortic coarctation require aortic valve surgery at a significantly younger age and more frequently for aortic regurgitation compared to those with isolated bicuspid aortic valve.
BAV patients with prior coarctation repair may need earlier regurgitation surveillance; leaves open whether history modifies surgical thresholds.
OBJECTIVES: A small proportion of patients undergoing bicuspid aortic valve (BAV) intervention have had prior repair of aortic coarctation (CoA). We aimed to describe phenotypic differences between BAV patients, comparing those with versus those without previous coarctation repair. METHODS: 556 adults with BAV who had undergone aortic valve and/or ascending aortic surgery were identified, and relevant clinical and operative details were retrospectively analysed. RESULTS: Of the total cohort, 532 patients (95.7%) had isolated BAV ('BAV-only'), and 24 (4.3%) had had a previous successful CoA repair ('BAV-CoA'). The median age at surgery was significantly lower in BAV-CoA patients compared with BAV-only (median, IQR: 40 years, 26-57 vs 62 years, 51-69, p<0.001). Indications for surgery also differed, with BAV-CoA patients much more likely to undergo surgery for aortic regurgitation (BAV-CoA 38% vs BAV-only 13%, p<0.001); patients with isolated BAV were more likely to require surgery for aortic stenosis (BAV-only 75% vs BAV-CoA 50%, p<0.001). Two different BAV morphotypes were commoner in the BAV-CoA group; type 0 valves (24% vs 8%, p<0.05) and type 2 valves (12% vs 3%, p<0.05). The proportion of patients undergoing concomitant aortic surgery at the time of valve surgery were similar (BAV-only 38% vs BAV-CoA 42%, p=0.8). CONCLUSION: In adult patients undergoing aortic valve surgery for BAV disease, those with a prior history of repaired CoA underwent surgery at a very much younger age, and a higher proportion required intervention for aortic regurgitation.
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Lim et al. (2020) conducted a cohort in Bicuspid aortic valve (n=556). Prior repair of aortic coarctation vs. Isolated bicuspid aortic valve (no prior coarctation repair) was evaluated on Indication for surgery: aortic regurgitation (p=<0.001). Adults with bicuspid aortic valve and prior coarctation repair underwent surgery at a younger age and more frequently for aortic regurgitation (38% vs 13%, p<0.001) than those without prior repair.
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