Key result
BAV is linked to ~56% lower mortality versus TAV in native valve endocarditis.
Why the study?
Clinical outcomes after surgical treatment for endocarditis in patients with bicuspid aortic valves were not well characterized.
Does bicuspid aortic valve morphology improve all-cause mortality in patients undergoing aortic valve surgery for endocarditis compared to tricuspid aortic valve morphology?
Cohort (n=338)
No
Does bicuspid aortic valve morphology improve all-cause mortality in patients undergoing aortic valve surgery for endocarditis compared to tricuspid aortic valve morphology?
Hazard Ratio: 0.64 (95% CI 0.39–1.05)
Absolute Event Rate: 21% vs 36%
p-value: p=0.076
In patients undergoing surgery for native valve endocarditis, having a bicuspid aortic valve is associated with improved long-term survival compared to a tricuspid aortic valve, despite a higher prevalence of perivalvular abscess.
Bicuspid morphology associated with lower mortality in native valve endocarditis surgery; leaves open generalizability and mechanisms pending prospective validation.
Background: The objective of this study is to investigate clinical outcomes in patients with bicuspid aortic valves (BAV) after surgical treatment for endocarditis. Methods: This was a population-based, observational cohort study, conducted on all patients who received aortic valve surgery for native or prosthetic valve endocarditis at Karolinska University Hospital between 2002-2020. Baseline characteristics and postoperative complications were collected from the institutional surgical database and patient medical charts. The primary endpoint was all-cause mortality. We used unadjusted and adjusted Cox regression to determine the association between valve morphology and long-term mortality. Results: Of the 338 patients, 122 (36%) had a BAV and 216 (64%) had a tricuspid aortic valve (TAV). The mean follow-up was 5.8 years (maximum 18.4 years). Survival rates at one, five, ten and 14 years were 88%, 81%, 78% and 76% versus 85%, 69%, 58% and 43%, in BAV and TAV patients, respectively [adjusted hazard ratio (HR) 0.64; 95% confidence interval (CI): 0.39-1.05]. In patients with native valve endocarditis, those with BAV had lower all-cause mortality compared to those with TAV (adjusted HR 0.44; 95% CI: 0.22-0.89), despite having a higher prevalence of perivalvular abscess (40% versus 22%, respectively, in BAV and TAV patients). In patients with prosthetic valve endocarditis, original valve morphology did not affect all-cause mortality (adjusted HR 1.94; 95% CI: 0.64-5.87). Conclusions: In patients with native valve endocarditis, a BAV was associated with improved survival after surgical treatment. In patients with prosthetic valve endocarditis, survival was not affected by the original valve morphology of the patient.
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Bearpark et al. (2022) conducted a cohort in aortic valve endocarditis (n=338). Bicuspid aortic valve vs. Tricuspid aortic valve was evaluated on all-cause mortality (HR 0.64, 95% CI 0.39-1.05, p=0.076). In patients with native valve endocarditis, a bicuspid aortic valve was associated with lower all-cause mortality compared to a tricuspid aortic valve (adjusted HR 0.44), whereas survival did not differ in prosthetic valve endocarditis.
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