Mechanical aortic valve replacement and the Ross procedure significantly reduced abnormal rotational flow in patients with bicuspid aortic valve disease, unlike bioprosthetic replacement.
Cross-Sectional (n=90)
No
Does aortic valve replacement normalize abnormal aortic flow patterns in patients with bicuspid aortic valve disease?
Mechanical aortic valve replacement and the Ross procedure tend to normalize abnormal aortic flow patterns in bicuspid aortic valve disease, whereas bioprosthetic valves leave remnant abnormal helical flow.
Absolute Event Rate: 7.3% vs 30.4%
p-value: p=0.001
Abnormal aortic flow patterns in bicuspid aortic valve disease (BAV) may be partly responsible for the associated aortic dilation. Aortic valve replacement (AVR) may normalize flow patterns and potentially slow the concomitant aortic dilation. We therefore sought to examine differences in flow patterns post AVR. Ninety participants underwent 4D flow cardiovascular magnetic resonance: 30 BAV patients with prior AVR (11 mechanical, 10 bioprosthetic, 9 Ross procedure), 30 BAV patients with a native aortic valve and 30 healthy subjects. The majority of subjects with mechanical AVR or Ross showed normal flow pattern (73% and 67% respectively) with near normal rotational flow values (7.2 ± 3.9 and 10.6 ± 10.5 mm2/ms respectively vs 3.8 ± 3.1 mm2/s for healthy subjects; both p > 0.05); and reduced in-plane wall shear stress (0.19 ± 0.13 N/m2 for mechanical AVR vs. 0.40 ± 0.28 N/m2 for native BAV, p 0.05), and a similar pattern for wall shear stress. Data before and after AVR (n = 16) supported these findings: mechanical AVR showed a significant reduction in rotational flow (30.4 ± 16.3 → 7.3 ± 4.1 mm2/ms; p < 0.05) and in-plane wall shear stress (0.47 ± 0.20 → 0.20 ± 0.13 N/m2; p < 0.05), whereas these parameters remained similar in the bioprosthetic AVR group. Abnormal flow patterns in BAV disease tend to normalize after mechanical AVR or Ross procedure, in contrast to the remnant abnormal flow pattern after bioprosthetic AVR. This may in part explain different aortic growth rates post AVR in BAV observed in the literature, but requires confirmation in a prospective study.
Bissell et al. (Thu,) conducted a cross-sectional in Bicuspid aortic valve disease (n=90). Mechanical aortic valve replacement vs. Pre-operative baseline was evaluated on Absolute rotational flow (mm2/ms) (p=0.001). Mechanical aortic valve replacement and the Ross procedure significantly reduced abnormal rotational flow in patients with bicuspid aortic valve disease, unlike bioprosthetic replacement.