Key result
Surgical aortic valve repair in patients with bicuspid aortic valve disease demonstrated a pooled 10-year survival of 0.912 (95% CI 0.845-0.979), though valve-related reinterventions were common.
Why the study?
What are the survival and reintervention outcomes following surgical aortic valve repair in patients with bicuspid aortic valve disease?
Meta-Analysis (n=2,010)
What are the survival and reintervention outcomes following surgical aortic valve repair in patients with bicuspid aortic valve disease?
Surgical aortic valve repair in selected patients with bicuspid aortic valve disease is associated with favorable long-term survival, though valve-related reinterventions remain common.
Supports repair consideration in selected bicuspid patients despite reinterventions; extends meta-analytic evidence but leaves optimal strategy open for RCTs.
Aortic valve repair is still emerging, and its role in the treatment of bicuspid aortic valve disease (BAVD) is not yet fully understood. Our objective is to synthesise available evidence on outcomes after surgical aortic valve repair in patients with BAVD. We conducted a systematic review of clinical studies using prespecified methods for searching, identifying and selecting eligible studies in 4 databases, and synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers independently reviewed full-text articles and extracted data. The results of included studies were quantitatively synthesised in frequentist meta-analyses. We included 11 aortic valve repair studies or study arms with a total of 2010 participants. Pooled estimates for the proportion of patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995 (95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993) and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean follow-up of 3.5 years. Proportion of patients with valve-related reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9 years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100 patient-years. Outcome reporting was insufficient to pool the results for a number of predefined outcomes. In conclusion, existing evidence on aortic valve repair in BAVD is limited to mostly small case series, case-control and small retrospective cohort studies. Despite the low quality, available evidence suggests favourable survival outcomes after aortic valve repair in selected patients with BAVD. Valve-related reinterventions at follow-up are common in all patients undergoing repair surgery.
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Salcher‐Konrad et al. (2016) conducted a meta-analysis in Bicuspid aortic valve disease (BAVD) (n=2,010). Surgical aortic valve repair was evaluated on Proportion of patients surviving at 10 years (95% CI 0.845 to 0.979). Surgical aortic valve repair in patients with bicuspid aortic valve disease demonstrated a pooled 10-year survival of 0.912 (95% CI 0.845-0.979), though valve-related reinterventions were common.
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