Bicuspid aortic valve outcomes

Abstract

Background: Bicuspid aortic valve is the most common CHD. Its association with early valvular dysfunction, endocarditis, thoracic aorta dilatation, and aortic dissection is well established. Objective: The aim of this study was to assess the incidence and predictors of cardiac events in adults with bicuspid aortic valve. Methods: We carried out a retrospective analysis of cardiac outcomes in ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre. Outcomes were defined as follows: interventional -intervention on the aortic valve or thoracic aorta; medical -death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission; and a composite end point of both. Kaplan-Meier curves were generated to determine event rates, and predictors of cardiac events were determined by multivariate analysis. Results: A total of 227 patients were followed-up over 13 ± 9 years; 29% of patients developed severe aortic valve dysfunction and 12.3% reached ascending thoracic aorta dimensions above 45 mm. At least one cardiac outcome occurred in 38.8% of patients, with an incidence rate at 20 years of follow-up of 47 ± 4%; 33% of patients were submitted to an aortic valve or thoracic aorta intervention. Survival 20 years after diagnosis was 94 ± 2%. Independent predictors of the composite end point were baseline moderate-severe aortic valve dysfunction (hazard ratio, 3.19; 95% confidence interval, 1.35-7.54; p < 0.01) and aortic valve leaflets calcification (hazard ratio, 4.72; 95% confidence interval, 1.91-11.64; p < 0.005). Conclusions: In this study of bicuspid aortic valve, the long-term survival was excellent but with occurrence of frequent cardiovascular events. Baseline aortic valve calcification and dysfunction were the only independent predictors of events.

Contemporary natural history of bicuspid aortic valve disease: a systematic review

“…This is generally reported apart from surgical intervention for coexisting coarctation, which was present generally in 1%–7% of patients,5–8 14 15 except for the studies by Tzemos et al (25%)7 and Rodrigues et al (18.9%) 13. Current guidelines emphasise routine surveillance and early elective surgical intervention, beyond specific aortic diameter thresholds 32 33…”

Clinical and pathophysiological aspects of bicuspid aortic valve disease

“…The other patients will follow the large population studies in adults where <1% will dissect over 10–20 years 2 64 , 75 If we assume that 1% of the general population has a bicuspid aortic valve and 10% of these individuals have an undiagnosed relative with a bicuspid aortic valve, we will identify 1000 persons per 1 million citizens and probably prevent 10 dissections over 10–20 years if the identified patients adhere to the follow-up programme. The remaining 990 individuals can be regarded as over-diagnosed with a bicuspid aortic valve and many unnecessary echocardiograms will be done on a population scale 12 .…”

Impaction of Regurgitation Jet on Anterior Mitral Leaflet Causes Diastolic Dysfunction in Patients With Bicuspid Aortic Valve and Mild Insufficiency: A Cardiovascular Magnetic Resonance Study

“…Moreover, BAV condition per se leads to a greater incidence of cardiovascular complications as compared to the general population (dilation or dissection of the thoracic aorta, aortic valve stenosis or insu ciency, endocarditis and myocardial ischemia) [22][23][24][25]. Furthermore, PJ group showed increased aortic annulus diameters as compared to the other groups, suggesting the possibility of additional pathological mechanisms related to the jet eccentricity and cusps asymmetry.…”