Comparison of Outcomes and Presentation in Men-Versus-Women With Bicuspid Aortic Valves Undergoing Aortic Valve Replacement

Andrei, Adin Cristian; Yadlapati, Ajay; Malaisrie, S. Chris; Puthumana, Jyothy; Li, Zhi; Rigolin, Vera H.; Mendelson, Marla A.; Clennon, Colleen; Kruse, Jane; Fedak, Paul W.M.; Thomas, James D.; Higgins, Jennifer; Rinewalt, Daniel; Bonow, Robert O.; McCarthy, Patrick M.

doi:10.1016/j.amjcard.2015.04.017

Cited by 35 publications

(40 citation statements)

References 25 publications

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“…Across the 3 cohorts studied, significant AR was significantly more common in men at baseline, follow‐up, and at AVR referral. Conversely, AS was more common in women only at AVR referral, as recently observed . Studies have identified an aortovalvular phenotype (“root phenotype”) characterized by AR, root dilatation, and male predominance .…”

Section: Discussionsupporting

confidence: 53%

Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts

Michelena

Suri²,

Katan

et al. 2016

JAHA

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BackgroundSex‐related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic‐clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic‐clinical stages remains undetermined.Methods and ResultsAnalysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35±21 years, follow‐up 16±7 years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51±16 years, follow‐up 9±6 years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62±14 years, follow‐up 6±5 years). For the community cohort, 20‐year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all P≤0.04); for a total BAV‐related morbidity risk of 52±4% vs 35±6% in women (P=0.01). The cohort's 25‐year survival was identical to that in the general population (P=0.98). AR independently predicted mortality in women (P=0.001). Baseline AR was more common in men (P≤0.02) in the tertiary cohort, with 20‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.16 (95% confidence interval [CI] 1.05‐1.29) for men versus 1.67 (95% CI 1.38‐2.03) for women (P=0.001). AR independently predicted mortality in women (P=0.01). Baseline AR and infective endocarditis were higher in men (both ≤0.001) for the surgical referral cohort, with 15‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.34 (95% CI 1.22‐1.47) for men versus 1.63 (95% CI 1.40‐1.89) for women (P=0.026). AR and NYHA class independently predicted mortality in women (both P≤0.04).ConclusionsWithin evolving echocardiographic‐clinical stages, the long‐term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV‐related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.

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Section: Discussionsupporting

confidence: 53%

Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts

Michelena

Suri²,

Katan

et al. 2016

JAHA

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“…There was a male predominance with a male to female ratio of 3:1 5–10 12–17. In one study that reported on gender-specific outcomes for patients undergoing AVR (thus not included in data synthesis), women were older, had less AR and had more comorbidities with a higher operative risk, but short-term and long-term outcomes were similar to that of men 18. Similarly, Michelena et al showed similar long-term survival in both genders, but women had higher risk of death in the clinical and surgical tertiary referral settings, whereas men had worse BAV-related morbidity in the community settings 14…”

Section: Resultsmentioning

confidence: 99%

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

Masri

Svensson

Griffin

et al. 2017

Heart

162

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We performed a systematic review of the current state of the literature regarding the natural history and outcomes of bicuspid aortic valve (BAV). PubMed and the reference lists of the included articles were searched for relevant studies reporting on longitudinal follow-up of BAV cohorts (mean follow-up ≥2 years). Studies limited to patients undergoing surgical interventions were excluded. 13 studies (11 502 patients with 2-16 years of follow-up) met the inclusion criteria. There was a bimodal age distribution (30-40 vs ≥50 years), with a 3:1 male to female ratio. Complications included moderate to severe aortic regurgitation (prevalence 13%-30%), moderate to severe aortic stenosis (12%-37%), infective endocarditis (2%-5%) and aortic dilatation (20%-40%). Aortic dissection or rupture was rare, occurring in 38 patients (0.4%, 27/6446 in native BAV and 11/2232 in post). With current aggressive surveillance and prophylactic surgical interventions, survival in three out of four studies was similar to that of a matched general population. In this systematic review, valvular dysfunction warranting surgical intervention in patients with BAV were common, aortic dissection was rare and, with the current management approach, survival was similar to that of the general population.

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“…This may explain the higher prevalence of aortic regurgitation in men compared with women. Andrei et al 4 reported larger aortic dimensions in men when compared with women (43.6±7.9 mm versus 38.8±9.3 mm, respectively; P<0.001), but the location of the aortic dilatation was not specified. Of interest, the prevalence of hypertension was not different between men and women.…”

Section: Sex Differences In Aortic Dimensions and Aortopathymentioning

confidence: 99%

“…3 In addition, women were referred for surgical aortic valve replacement at an older age than men, and aortic aneurysm repair was less frequently performed in women than in men. 4 However, these results may not be extended to large unselected cohorts of patients with BAV without indication for surgery. Accordingly, this study evaluated the sex-related differences in valve morphology, valvular function at presentation (normal, stenosis, and regurgitation), aortopathy, frequency of endocarditis, and aortic dissection in a large multicenter, international registry of patients diagnosed with BAV.…”

mentioning

confidence: 99%

Sex Differences in Phenotypes of Bicuspid Aortic Valve and Aortopathy

Kong

Regeer

et al. 2017

Circ: Cardiovascular Imaging

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Background-This large multicenter, international bicuspid aortic valve (BAV) registry aimed to define the sex differences in prevalence, valve morphology, dysfunction (aortic stenosis/regurgitation), aortopathy, and complications (endocarditis and aortic dissection). Methods and Results-Demographic, clinical, and echocardiographic data at first presentation of 1992 patients with BAV (71.5% men) were retrospectively analyzed. BAV morphology and valve function were assessed; aortopathy configuration was defined as isolated dilatation of the sinus of Valsalva or sinotubular junction, isolated dilatation of the ascending aorta distal to the sinotubular junction, or diffuse dilatation of the aortic root and ascending aorta. New cases of endocarditis and aortic dissection were recorded. There were no significant sex differences regarding BAV morphology and frequency of normal valve function. When presenting with moderate/severe aortic valve dysfunction, men had more frequent aortic regurgitation than women (33.8% versus 22.2%, P<0.001), whereas women were more likely to have aortic stenosis (34.5% versus 44.1%, P<0.001). Men had more frequently isolated dilatation of the sinus of Valsalva or sinotubular junction (14.2% versus 6.7%, P<0.001) and diffuse dilatation of the aortic root and ascending aorta (16.2% versus 7.3%, P<0.001) than women. Endocarditis (4.5% versus 2.5%, P=0.037) and aortic dissections (0.5% versus 0%, P<0.001) occurred more frequently in men. Conclusions-Although there is a male predominance among patients with BAV, men with BAV had more frequently moderate/severe aortic regurgitation at first presentation compared with women, whereas women presented more often with moderate/severe aortic stenosis compared with men. Furthermore, men had more frequent aortopathy than women. (Circ Cardiovasc Imaging. 2017;10:e005155.

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Comparison of Outcomes and Presentation in Men-Versus-Women With Bicuspid Aortic Valves Undergoing Aortic Valve Replacement

Cited by 35 publications

References 25 publications

Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts

Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts

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

Sex Differences in Phenotypes of Bicuspid Aortic Valve and Aortopathy

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