Valve Phenotype and Risk Factors of Aortic Dilatation After Aortic Valve Replacement in Japanese Patients With Bicuspid Aortic Valve

Abstract

Background:The aim of this study was to assess the risk factors for dilatation of the aorta over time in Japanese patients with bicuspid aortic valve (BAV) undergoing aortic valve replacement (AVR), focusing on the possible impact of valve fusion phenotype. Methods and Results:Of 167 BAV patients undergoing AVR (24% of overall AVR patients, n=702), 135 patients in whom surgical intervention for the aorta was not undertaken were focused on (74 had right-left fusion and 61 non-right-left fusion type). During a mean follow up of 5.2 years, aortic growth rate (mm/year) of the ascending aorta was similar between the valve phenotype. In multivariate logistic regression, the presence of aortic regurgitation > moderate was significantly associated with a rapid dilatation of the ascending aorta, defined as >0.7 mm/year (odds ratio 2.1, 95% confidence interval 1.2-3.7, P=0.03). Independent predictors of dilatation of the aorta up to more than 45 mm were: a diameter of the ascending aorta >40 mm at the time of surgery (odds ratio 3.7, 95% confidence interval 1.2-11.4, P=0.02) and length of follow up (odds ratio 1.3-increase per year, 95% confidence interval 1.0-1.5, P=0.04). Conclusions:The presence of aortic regurgitation and the ascending aorta of >40 mm at the time of surgery emerged as significant predictors of dilatation of the aorta after AVR but valve fusion phenotype was not. (Circ J 2016; 80: 1356 -1361

Clinical Characteristics of Korean Patients with Bicuspid Aortic Valve Who Underwent Aortic Valve Surgery

“…The prevalence of the type 1 phenotype in western countries was over 70% (up to 86%), whereas that reported in Japan and Korea was less than 60% ( Table 3 and Figure 5 ). 7) 8) 12) 13) 26) 27) 28) One potential explanation for this difference is different study cohorts: our study included BAV patients with significant valvular dysfunction that needed AV surgery, whereas western reports based on imaging studies included variable degrees of valve dysfunction. Currently, the clinical impact of ethnic differences on the frequency of specific BAV phenotypes is unclear; however, considering the different embryologic pathogenesis of different BAV phenotypes, 29) these could manifest in ethnically-based differences in clinical features or outcomes in patients with BAV.…”

Longer-term results, z scores, and decision nomograms for treatment of the ascending aorta in 1693 bicuspid aortic valve operations

“…In these young patients, the AA after valve intervention will grow with patient-and hemodynamic-specific variable progression over a long life span and potentially and unpredictably reaching sooner or later a more ''risky'' area necessitating continuous surveillance and new decision making on AA treatment as a redo. In this respect, the report of Kinoshita and colleagues 24 is of interest, showing that an AA diameter greater than 40 mm at aortic valve replacement emerged as a significant predictor for dilatation later on. This supports earlier experience showing that 25% of patients with AA diameter greater than 40 mm and aortic valve surgery for aortic insufficiency required a subsequent AA surgery.…”

Differential flow improvements after valve replacements in bicuspid aortic valve disease: a cardiovascular magnetic resonance assessment

“…To date there are few longitudinal studies examining the effect of AVR on aortic growth rate and mechanical and bioprosthetic AVR are not separately reported within these studies. While some showed an increased growth rate after AVR (echocardiography [ 25 , 27 , 28 ]; computed tomography (CT) [ 29 ]), others showed an overall reduction in aortic growth rate after AVR (echocardiography [ 23 ]; echocardiography or CT [ 30 ]; CT or CMR [ 26 ]). One explanation for these discrepant findings may be that flow profiles differ post mechanical and post bioprosthetic AVR as suggested by the findings in our hypothesis-generating study.…”