Key result
Tricuspid aortic valves were associated with a higher degree of elastic fibre fragmentation and mucoid extracellular matrix accumulation in the ascending aorta compared to bicuspid valves (P<0.001).
Why the study?
The underlying pathogenesis of aortic wall changes and aneurysmal dilation in patients with a bicuspid aortic valve remains debated.
Do histological abnormalities of the ascending aorta differ between patients with bicuspid versus tricuspid aortic valves?
Observational (n=376)
No
Do histological abnormalities of the ascending aorta differ between patients with bicuspid versus tricuspid aortic valves?
p-value: p=<0.001
Patients with tricuspid aortic valves and ascending aorta dilation or dissection exhibit more severe histological abnormalities in the aortic wall compared to those with bicuspid aortic valves.
Challenges view of more severe aortopathy in bicuspid valves; leaves open histology-guided thresholds in dilated aortas.
OBJECTIVES: Patients with a bicuspid aortic valve (BAV) often present with a dilated ascending aorta. However, the underlying pathogenesis for the observed changes in the aortic wall and the resulting aneurysmal dilation remains a subject of debate. This study aims to compare the histological abnormalities of the ascending aorta in BAV and tricuspid aortic valve (TAV) patients and their correlation with aortic diameter and patient age. METHODS: A total of 376 patients from our institution's clinical database were included in the retrospective analysis. These patients underwent either elective surgery for ascending aorta dilation or emergency surgery for aortic dissection, either isolated or with a structurally diseased aortic valve. After excision, the ascending aorta samples were analysed by a pathologist. RESULTS: On histological examination, a higher degree of elastic fibre fragmentation and loss and mucoid extracellular matrix accumulation was present in the samples from TAV patients when compared with that from BAV patients (P < 0.001). However, correlation was poor for all variables when considering aortic diameter and histological abnormalities or age and histological abnormalities in both BAV and TAV patients. CONCLUSIONS: Our study demonstrates a greater incidence of severe histological abnormalities in TAV patients when compared with BAV patients.
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Karalko et al. (2020) conducted an observational in Dilated ascending aorta or aortic dissection (n=376). Tricuspid aortic valve vs. Bicuspid aortic valve was evaluated on Histological abnormalities of the ascending aorta (elastic fibre fragmentation and loss, mucoid extracellular matrix accumulation) (p=<0.001). Tricuspid aortic valves were associated with a higher degree of elastic fibre fragmentation and mucoid extracellular matrix accumulation in the ascending aorta compared to bicuspid valves (P<0.001).
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