Key result
Bicuspid aortic valve morphology linked to ~2.1-fold higher prevalence of non-leaflet invasive complications vs tricuspid.
Why the study?
Detailed operative evidence comparing invasive anatomy and reconstruction between bicuspid and tricuspid aortic valve native infective endocarditis cases is limited.
Does bicuspid aortic valve morphology increase the risk of non-leaflet invasive complications in adults undergoing surgery for native aortic valve infective endocarditis?
Cohort (n=317)
Does bicuspid aortic valve morphology increase the risk of non-leaflet invasive complications in adults undergoing surgery for native aortic valve infective endocarditis?
Relative Risk: 2.08 (95% CI 1.41–3.06)
Absolute Event Rate: 44.2% vs 18.6%
In patients with native aortic valve infective endocarditis, bicuspid aortic valve morphology is associated with approximately double the risk of non-leaflet invasive complications, predominantly abscesses, compared to tricuspid anatomy.
May warrant closer preoperative planning in bicuspid aortic valve endocarditis; extends observational data on complications but leaves causality and practice change open.
Background: Detailed operative evidence comparing invasive anatomy and reconstruction between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) cases of native-valve infective endocarditis is limited. We examined the association of BAV morphology with non-leaflet invasive complications and infection-related reconstruction. Methods: We retrospectively studied 317 adults who underwent surgery for native aortic valve infective endocarditis from 2013 through 2025 (113 BAV; 204 TAV). The primary outcome was any non-leaflet invasive complication; infection-related reconstruction was a secondary operative outcome reflecting operative management of invasive anatomy. Modified Poisson regression estimated adjusted prevalence ratios (aPRs), corresponding 95% confidence intervals (CIs), and marginally standardized absolute differences. Site-specific and invasive-subgroup analyses were exploratory. Results: Patients with BAV were younger, more frequently male, and had a lower comorbidity burden. Non-leaflet invasive complications occurred in 44.2% of patients with BAV and 18.6% with TAV (aPR, 2.08; 95% CI, 1.41–3.06; adjusted absolute difference, 21.1 percentage points; 95% CI, 9.6–32.6). Abscess involving non-leaflet structures was more frequent in BAV than in TAV (43.4% vs. 16.7%; p < 0.001). In the full cohort, aortic annular and left ventricular outflow tract involvement were more frequent in BAV. Infection-related reconstruction was performed in 31.9% of patients with BAV and 15.2% of those with TAV. Within the invasive subgroup, reconstruction was performed in 72.0% and 81.6% of BAV and TAV cases, respectively (unadjusted PR, 0.88; 95% CI, 0.70–1.11). Early mortality was low in both groups, and the adjusted analysis did not identify a clear difference in long-term mortality. Conclusions: Bicuspid morphology was associated with a higher prevalence of non-leaflet invasive complications, predominantly abscess, and a higher overall frequency of infection-related reconstruction.
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Zhai et al. (2026) conducted a cohort in Native aortic valve infective endocarditis (n=317). Bicuspid aortic valve morphology vs. Tricuspid aortic valve morphology was evaluated on Any non-leaflet invasive complication (aPR 2.08, 95% CI 1.41-3.06). Bicuspid aortic valve morphology was associated with a higher prevalence of non-leaflet invasive complications compared to tricuspid aortic valves (44.2% vs 18.6%; aPR 2.08; 95% CI 1.41-3.06).
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