Key result
Leaving mild-to-moderate BAV untreated during ascending aorta replacement yields ~97% 12-year survival.
Why the study?
It is unclear whether concomitant aortic valve replacement should be performed in patients with mild-to-moderate bicuspid aortic valve disease undergoing isolated supracoronary ascending aorta replacement.
Does leaving mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement result in low rates of reoperation and valve deterioration?
Cohort (n=75)
Does leaving mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement result in low rates of reoperation and valve deterioration?
Mild-to-moderate bicuspid aortic valve regurgitation does not significantly worsen up to 10 years after isolated supracoronary ascending aorta replacement, suggesting concomitant valve replacement may not be necessary.
Answers are grounded in this paper and cite their sources.
Untreated mild-moderate BAV disease shows low progression after isolated ascending replacement; leaves open whether routine concomitant AVR is warranted.
Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.
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Verzini et al. (2020) conducted a cohort in Mild-to-moderate bicuspid aortic valve disease (n=75). Isolated supracoronary ascending aorta replacement was evaluated on Overall survival at 12 years (95% CI 83.16-99.63). Isolated supracoronary ascending aorta replacement without treating mild-to-moderate bicuspid aortic valve disease yielded 97.4% overall survival and a 2.6% reoperation rate at 12 years.
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