Why the study?
Patients with bicuspid aortic valves tend to develop dilation of the ascending aorta, but the impact of leaflet fusion pattern on aortic root diameter and surgical outcomes remained to be analyzed.
Does bicuspid aortic valve leaflet fusion morphology impact ascending aorta dilation and outcomes after aortic valve replacement compared to tricuspid aortic valve disease?
Does bicuspid aortic valve leaflet fusion morphology impact ascending aorta dilation and outcomes after aortic valve replacement compared to tricuspid aortic valve disease?
Bicuspid aortic valve patients with right-noncoronary cusp fusion have greater preoperative ascending aorta dilation compared to those with right-left fusion or tricuspid aortic valves, though sizes equalize after aortic valve replacement.
R/N fusion links to greater preoperative ascending aortic dilation in BAV; leaves open whether fusion pattern alters surveillance or long-term aortopathy risk.
BACKGROUND: Patients with bicuspid aortic valves (BAVs) tend to develop dilation of the ascending aorta. The aim of this study was to analyze the impact of leaflet fusion pattern on aortic root diameter and outcomes in patients undergoing surgery for BAV vs tricuspid aortic valve (TAV) disease. METHODS: This is a retrospective review of 90 patients with aortic valve disease (mean [SD] age, 51.5 [8.2] years) who underwent aortic valve replacement for BAV (n = 60) and TAV (n = 30). Fusion of right-left (R/L) coronary cusps was identified in 45 patients, whereas the remaining 15 patients had right-noncoronary (R/N) cusp fusion. Aortic diameter was measured at 4 levels, and Z values were computed. RESULTS: There were no significant differences between the BAV and TAV groups for age, weight, aortic insufficiency grade, or size of implanted prostheses. However, a higher preoperative peak gradient at the aortic valve was significantly associated with R/L fusion (P = .02). Preoperative Z values of ascending aorta and sinotubular junction diameter were significantly higher in patients with R/N fusion than with the R/L (P < .001 and P = .04, respectively) and TAV (P < .001 and P < .05, respectively) subgroups. During the follow-up period (mean [SD], 2.7 [1.8] years), 3 patients underwent a redo procedure. At the last follow-up, the sizes of ascending aorta were similar among all 3 patient groups. CONCLUSION: This study suggests that preoperative dilation of the ascending aorta is more common in patients with R/N fusion than in patients with R/L and TAV but is not significantly different between all groups in the early follow-up period. R/L fusion was associated with an increased risk of preoperative presence of aortic stenosis.
No takes yet. Share an insight, caveat, or question.
Bibevski et al. (2023) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: