Key result
Bicuspid aortic valve insufficiency was associated with a significantly higher rate of moderate/severe aortic media elastic fibre loss compared to BAV stenosis (80% vs 29%; OR 9.3, 95% CI 3.2-29.8).
Why the study?
Does bicuspid aortic valve insufficiency compared to stenosis associate with greater proximal aortic media elastic fibre loss in patients with proximal aortic aneurysm ≥50 mm?
Cohort (n=79)
No
Does bicuspid aortic valve insufficiency compared to stenosis associate with greater proximal aortic media elastic fibre loss in patients with proximal aortic aneurysm ≥50 mm?
Odds Ratio: 9.3 (95% CI 3.2–29.8)
Absolute Event Rate: 80% vs 29%
p-value: p=<0.001
In patients with bicuspid aortic valve and proximal aortic aneurysm ≥50 mm, BAV insufficiency is associated with significantly greater aortic media elastic fiber loss than BAV stenosis, suggesting distinct pathophysiological mechanisms of aortopathy.
Suggests distinct aortopathy phenotypes by BAV lesion type; leaves open whether lesion-specific thresholds should guide surgery.
OBJECTIVES: The aim of this study was to evaluate aortic media changes in bicuspid aortic valve (BAV) patients who underwent aortic valve replacement (AVR) and simultaneous replacement of the proximal aorta for BAV stenosis vs BAV insufficiency. METHODS: Review of our institutional BAV database identified a subgroup of 79 consecutive BAV patients (mean age 52.3 ± 13 years, 81% men) with BAV stenosis or insufficiency and concomitant proximal aortic dilatation of ≥50 mm who underwent AVR and simultaneous replacement of proximal aorta from 1995 through 2005. All cases of BAV disease and concomitant ascending aortic dilatation of 40-50 mm underwent isolated AVR and therefore were excluded from this analysis. Proximal aortic media elastic fibre loss (EFL) was assessed (graded 0 to 3+) and compared between patients with BAV stenosis (Group I, n = 44) vs BAV insufficiency (Group II, n = 35). Follow-up (690 patient-years) was 100% complete and 9.1 ± 4.6 years long. RESULTS: Mean aortic media EFL was 1.3 ± 0.7 in Group I vs 2.5 ± 0.8 in Group II (P = 0.03). Moderate/severe EFL (i.e. defined as grade 2+/3+) was found in 13 patients (29%) in Group I vs 28 patients (80%) in Group II (P < 0.001). Logistic regression identified BAV insufficiency as the strongest predictor of moderate/severe EFL (OR 9.3; 95% CI 3.2-29.8, P < 0.001). Valve-related event-free survival was 64 ± 8% in Group I vs 93% ± 5% in Group II at 10 years postoperatively (P = 0.05). A total of 4 patients (5%, 3 from Group I and 1 from Group II) underwent redo aortic root surgery for prosthetic valve endocarditis during follow-up. CONCLUSIONS: Patients with BAV insufficiency and a proximal aorta of ≥50 mm have a significantly higher rate of moderate/severe EFL as compared to their counterparts with BAV stenosis.
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Girdauskas et al. (2013) conducted a cohort in Bicuspid aortic valve stenosis or insufficiency with proximal aortic aneurysm (n=79). Bicuspid aortic valve insufficiency vs. Bicuspid aortic valve stenosis was evaluated on Moderate/severe aortic media elastic fibre loss (grade 2+/3+) (OR 9.3, 95% CI 3.2-29.8, p=<0.001). Bicuspid aortic valve insufficiency was associated with a significantly higher rate of moderate/severe aortic media elastic fibre loss compared to BAV stenosis (80% vs 29%; OR 9.3, 95% CI 3.2-29.8).
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