Key result
BAV is associated with similar 12-year survival compared to TAV after VSARR.
Why the study?
Outcomes beyond 10 years for David V valve-sparing aortic root replacement (VSARR) in bicuspid aortic valve (BAV) patients have yet to be explored.
Does valve-sparing aortic root replacement in bicuspid aortic valve patients have similar long-term survival and reoperation rates compared to tricuspid aortic valve patients?
Cohort (n=677)
Yes
Does valve-sparing aortic root replacement in bicuspid aortic valve patients have similar long-term survival and reoperation rates compared to tricuspid aortic valve patients?
Hazard Ratio: 0.76 (95% CI 0.34–1.69)
Absolute Event Rate: 92% vs 89.9%
p-value: p=0.51
Valve-sparing aortic root replacement for bicuspid aortic valve patients offers excellent 12-year survival comparable to tricuspid aortic valve patients, although there is a higher incidence of late reoperation or reintervention.
May support valve-sparing root replacement in bicuspid patients; leaves open durability and reintervention questions from observational data.
OBJECTIVES: Outcomes beyond 10 years for David V valve-sparing aortic root replacement (VSARR) in bicuspid aortic valve (BAV) patients have yet to be explored. We investigated long-term outcomes after BAV VSARR compared to VSARR for tricuspid aortic valve (TAV) patients. METHODS: A total of 677 patients with BAV (n = 171) and TAV (n = 506) underwent VSARR between 2005 and 2020 from 2 aortic centres, excluding those with dissection, endocarditis, stenosis or prior aortic valve (AV) surgery. Multivariable Cox regression compared adjusted survival over a 12-year period. Fine and Gray competing risk regression compared risk and cumulative incidence of reoperation/reintervention. Propensity score matching created balanced groups, and landmark analysis isolated outcomes beginning 4 years postoperatively. Finally, longitudinal mixed modelling assessed AV deterioration on echocardiogram. RESULTS: No difference was observed in 12-year survival of BAV versus TAV (propensity score matching 92.0% vs 89.9%, P = 0.97; multivariable hazard ratio 0.76, 95% confidence interval 0.34-1.69, P = 0.51). Adjusted 12-year cumulative incidence and risk of AV and/or proximal aorta reoperation/reintervention were not observed to be different (15.7% BAV vs 5.7% TAV, P = 0.37; subdistribution hazard ratio 1.54, 95% confidence interval 0.60-3.94, P = 0.36); however, landmark analysis showed increased incidence of late reoperation/reintervention in BAV versus TAV (11.7% vs 0.0%, P = 0.04). BAV was not associated with AV deterioration over time (BAV coefficient ± standard error: 0 ± 0.30, P = 1). CONCLUSIONS: VSARR for BAV patients has excellent 12-year survival and low reoperation/reintervention rates, which were not observed to be different from TAV patients. However, higher incidence of reoperation/reintervention was observed in the late years after BAV VSARR. Our study provides key information for surgical consultation of patients with bicuspid aortopathy.
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Levine et al. (2023) conducted a cohort in Bicuspid and tricuspid aortic valve requiring valve-sparing aortic root replacement (n=677). Bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV) was evaluated on 12-year survival (HR 0.76, 95% CI 0.34-1.69, p=0.51). Bicuspid aortic valve was associated with similar 12-year survival compared to tricuspid aortic valve after valve-sparing aortic root replacement (92.0% vs 89.9%; HR 0.76; 95% CI 0.34-1.69; P=0.51).
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