Hostname: page-component-7479d7b7d-767nl Total loading time: 0 Render date: 2024-07-11T06:25:57.293Z Has data issue: false hasContentIssue false
  • English
  • Français

Mid-term follow-up of aortic valve replacement for bicuspid aortic valve

Part of: Surgery

Published online by Cambridge University Press:  01 March 2021

Lingchao Liu ,
Tianbo Li ,
Bo Xu ,
Chencheng Liu ,
Fuqin Tang ,
Yingbin Xiao  and
Yong Wang Open the ORCID record for Yong Wang [Opens in a new window]
Lingchao Liu
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
Tianbo Li
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
Bo Xu
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
Chencheng Liu
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
Fuqin Tang
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
Yingbin Xiao
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
Yong Wang*
Affiliation:
Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, Chongqing, China
*
Author for correspondence: Y. Wang, MD, Department of Cardiovascular Surgery, The Second Affiliated Hospital (Xinqiao Hospital) of Chinese People’s Liberation Army Medical University, No. 183, Xinqiao Zhengjie, Shapingba District, Chongqing, 400037, China. Tel: 86-23-68774507. E-mail: yongwang201009@163.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The purpose of this study was to evaluate the mid-term outcome of aortic valve replacement for bicuspid aortic valve and tricuspid aortic valve and the related risk factors.

Methods:

From January 2014 to June 2019, 177 tricuspid aortic valve patients and 101 bicuspid aortic valve patients who underwent aortic valve replacement in our hospital were collected. 1:1 propensity score matching analysis was used to control the bias in patient selection. The perioperative and follow-up data between the two groups were compared. Independent risk factors which were associated with the continued dilatation of the ascending aorta were identified by univariate or multivariate logistic regression analysis.

Results:

After the matching procedure, 160 patients were included in the analysis (80 in each group). Baseline characteristics, intraoperative, and perioperative outcomes were similar between the two groups (all p > 0.05). Moreover, 67 patients in the tricuspid aortic valve group and 70 in the bicuspid aortic valve group completed the follow-up. The ascending aorta change, annual change rate, and the proportion of continuous dilation of ascending aorta in bicuspid aortic valve group were significantly higher than those in the tricuspid aortic valve group (p < 0.05). Multivariate logistic regression analysis showed that type 1 in bicuspid aortic valve (OR 5.173; 95% CI 1.772, 15.101; p = 0.003), aortic regurgitation (OR 3.673; 95% CI 1.133, 11.908; p = 0.030), and aortic valve stenosis with regurgitation (OR 6.489; 95% CI 1.726, 24.404; p = 0.006) were independent risk factors for the continued dilatation of the ascending aorta in all AV patients. Furthermore, the multivariate logistic regression analysis showed that type 1 in bicuspid aortic valve (OR 5.157; 95% CI 1.053, 25.272; p = 0.043), age ≥ 40 years (OR 6.956; 95% CI 1.228, 39.410; p = 0.028), and aortic regurgitation (OR 4.322; 95% CI 1.174, 15.911; p = 0.028) were independent risk factors for the continued dilatation of the ascending aorta in bicuspid aortic valve patients.

Conclusion:

Compared with tricuspid aortic valve patients, the ascending aorta of bicuspid aortic valve patients is more likely to continue to enlarge after aortic valve replacement. Type 1 in bicuspid aortic valve, age ≥ 40 years, and aortic regurgitation were the independent risk factors.

Keywords

Mid-term follow-upaortic valve replacementbicuspid aortic valvepropensity score-matched analysis
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 8 , August 2021 , pp. 1290 - 1296
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
Borger, MA, Fedak, PWM, Stephens, EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: full online-only version. J Thorac Cardiovasc Surg 2018; 156: e41–e74.CrossRefGoogle Scholar
Sievers, HH, Schmidtke, C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007; 133: 1226–1233.CrossRefGoogle ScholarPubMed
Siu, SC, Silversides, CK. Bicuspid aortic valve disease. J Am Coll Cardiol 2010; 55: 2789–2800.CrossRefGoogle ScholarPubMed
Hiratzka, LF, Creager, MA, Isselbacher, EM, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol 2016; 67: 724–731.CrossRefGoogle Scholar
El-Hamamsy, I, Yacoub, MH. A measured approach to managing the aortic root in patients with bicuspid aortic valve disease. Curr Cardiol Rep 2009; 11: 94–100.CrossRefGoogle ScholarPubMed
Girdauskas, E, Rouman, M, Disha, K, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease. J Am Coll Cardiol 2015; 66: 1409–14111.CrossRefGoogle ScholarPubMed
Girdauskas, E, Disha, K, Raisin, HH, et al. Risk of late aortic events after an isolated aortic valve replacement for bicuspid aortic valve stenosis with concomitant ascending aortic dilation. Eur J Cardio-Thorac Surg 2012; 42: 832–837.CrossRefGoogle ScholarPubMed
Nashef, SA, Roques, F, Sharples, LD, et al. EuroSCORE II. Eur J Cardio-Thorac Surg 2012; 41: 734–744.CrossRefGoogle ScholarPubMed
Masri, A, Kalahasti, V, Alkharabsheh, S, et al. Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves. J Thorac Cardiovasc Surg 2016; 151: 1650.e1–1659.e1.CrossRefGoogle ScholarPubMed
Borger, MA, Preston, M, Ivanov, J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg 2004; 128: 677–683.CrossRefGoogle ScholarPubMed
Mahadevia, R, Barker, AJ, Schnell, S, et al. Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy. Circulation 2014; 129: 673–682.CrossRefGoogle ScholarPubMed
Yasuda, H, Nakatani, S, Stugaard, M, et al. Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve. Circulation 2003; 108 (Suppl 1): 291–294.CrossRefGoogle ScholarPubMed
Wang, Y, Wu, B, Li, J, et al. Impact of aortic insufficiency on ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement in patients with a bicuspid aortic valve. Ann Thorac Surg 2016; 101: 1707–1714.CrossRefGoogle ScholarPubMed
Chim, YH, Davies, HA, Mason, D, et al. Bicuspid valve aortopathy is associated with distinct patterns of matrix degradation. J Thorac Cardiovasc Surg 2020; 160: e239–e257.CrossRefGoogle ScholarPubMed
Maguire, EM, Pearce, SWA, Xiao, R, et al. Matrix metalloproteinase in abdominal aortic aneurysm and aortic dissection. Pharmaceuticals (Basel, Switzerland) 2019; 12: 118.CrossRefGoogle ScholarPubMed
Rabkin, SW. The role matrix metalloproteinases in the production of aortic aneurysm. Prog Mol Biol Transl Sci 2017; 147: 239–265.CrossRefGoogle ScholarPubMed
Ikonomidis, JS, Ruddy, JM, Benton, SM Jr., et al. Aortic dilatation with bicuspid aortic valves: cusp fusion correlates to matrix metalloproteinases and inhibitors. Ann Thorac Surg 2012; 93: 457–463.CrossRefGoogle ScholarPubMed
Biaggi, P, Matthews, F, Braun, J, et al. Gender, age, and body surface area are the major determinants of ascending aorta dimensions in subjects with apparently normal echocardiograms. J Am Soc Echocardiogr 2009; 22: 720–725.CrossRefGoogle ScholarPubMed
Stock, S, Mohamed, SA, Sievers, HH. Bicuspid aortic valve related aortopathy. Gen Thorac Cardiovasc Surg 2019; 67: 93–101.CrossRefGoogle ScholarPubMed
Deveja, RP, Iliopoulos, DC, Kritharis, EP, et al. Effect of aneurysm and bicuspid aortic valve on layer-specific ascending aorta mechanics. Ann Thorac Surg 2018; 106: 1692–1701.CrossRefGoogle ScholarPubMed
Nishimura, RA, Otto, CM, Bonow, RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57–e185.CrossRefGoogle Scholar
Elefteriades, JA, Mukherjee, SK, Mojibian, H. Discrepancies in measurement of the thoracic aorta: JACC review topic of the week. J Am Coll Cardiol 2020; 76: 201–217.CrossRefGoogle Scholar