Key result
Moderate to severe aortic stenosis was significantly associated with surgical events in asymptomatic or mildly symptomatic patients with bicuspid aortic valve (HR 4.61; 95% CI 1.83-11.62; p=0.001).
Why the study?
Although bicuspid aortic valve is one of the most common congenital heart diseases, clinical outcome data remain limited.
Cohort (n=170)
No
Hazard Ratio: 4.61 (95% CI 1.83–11.62)
p-value: p=0.001
In asymptomatic or mildly symptomatic patients with bicuspid aortic valve, moderate to severe aortic stenosis and NYHA class ≥ 2 are significant predictors of requiring open heart surgery at mid-term follow-up.
May refine surgical risk stratification in bicuspid aortic valve; leaves open optimal intervention timing.
BACKGROUND: Although bicuspid aortic valve (BAV) is one of the most common congenital heart diseases, clinical outcome data regarding BAV are still limited. We evaluated clinical characteristics and mid-term clinical outcomes of asymptomatic Korean patients with bicuspid aortic valve. METHODS: We initiated a prospective registry in 2014 at a tertiary referral hospital. To develop a cohort of asymptomatic patients, we excluded patients who previously underwent open heart surgery (OHS) or who had OHS within 6 months of referral. RESULTS: A total of 170 patients (117 male [69%], age 50 ± 13 years) were enrolled. More than 70% (n = 124, 73%) were incidentally diagnosed with BAV during routine health examinations or preoperative screening for non-cardiac surgery. At the time of enrollment, moderate to severe aortic stenosis (AS) or regurgitation (AR) was present in 77 patients (45%) and 98 (58%) showed aortic dilation: 42 (25%) had non-significant valvular dysfunction without aortic dilation. During a median follow-up of 4 years, AS severity increased significantly (p < 0.001), while there was no significant change in AR severity (p = 0.361). A total of 27 patients (16%) underwent OHS, including isolated aortic valve (AV) surgery (n = 11, 41%), AV with combined aortic surgery (n = 12, 44%), and isolated aortic surgery (n = 4, 15%): no patient developed aortic dissection. Moderate to severe AS (hazard ratio [HR] 4.61; 95% confidence interval [CI] 1.83-11.62; p = 0.001), NYHA class ≥ 2 (HR 2.53; 95% CI 1.01-6.35; p = 0.048) and aortic dilation (HR 2.13; 95% CI 0.87-5.21; p = 0.099) were associated with surgical events. CONCLUSIONS: Progression patterns of valvular dysfunction and impacts of BAV phenotype on OHS should be explored in future studies with longer follow-up durations.
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Sun et al. (2019) conducted a cohort in Bicuspid aortic valve (n=170). Moderate to severe aortic stenosis vs. None or mild aortic stenosis was evaluated on Surgical events (open heart surgery) (HR 4.61, 95% CI 1.83-11.62, p=0.001). Moderate to severe aortic stenosis was significantly associated with surgical events in asymptomatic or mildly symptomatic patients with bicuspid aortic valve (HR 4.61; 95% CI 1.83-11.62; p=0.001).
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