Outcomes in adults with bicuspid aortic valves
Nikolaos Tzemos1, Judith Therrien, James Yip
1Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Insights
Adults with bicuspid aortic valve face cardiac events, with age and valve condition being key predictors. However, survival rates remain comparable to the general population over a 9-year follow-up.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Aortic Valve Disease
Background:
- Bicuspid aortic valve (BAV) is the most prevalent congenital heart anomaly in adults.
- Contemporary cardiac outcomes in BAV patients require systematic evaluation.
Purpose of the Study:
- To determine the frequency and predictors of cardiac outcomes in a large cohort of adults with BAV.
- To assess long-term cardiac event rates and survival in a contemporary BAV population.
Main Methods:
- A cohort study followed 642 consecutive ambulatory adults with BAV for a mean of 9 years.
- Multivariate analysis identified predictors of major cardiac events, including cardiac death, aortic interventions, dissection, aneurysm, and heart failure.
- Mortality rates were compared to age- and sex-matched general population estimates.
Main Results:
- Primary cardiac events occurred in 25% of patients, with aortic valve/ascending aorta interventions being most common (22%).
- Independent predictors for cardiac events included age >30 years, moderate/severe aortic stenosis, and moderate/severe aortic regurgitation.
- The 10-year survival rate was 96%, not significantly different from the general population.
Conclusions:
- Age, aortic stenosis severity, and aortic regurgitation severity are independent predictors of cardiac events in adults with BAV.
- Despite potential cardiac events, long-term survival for young adults with BAV is comparable to the general population.
Context:
Bicuspid aortic valve is the most common congenital cardiac anomaly in the adult population. Cardiac outcomes in a contemporary population of adults with bicuspid aortic valve have not been systematically determined.
Objective:
To determine the frequency and predictors of cardiac outcomes in a large consecutive series of adults with bicuspid aortic valve.
Design, Setting, And Participants:
Cohort study examining cardiac outcomes in 642 consecutive ambulatory adults (mean [SD] age, 35 [16] years; 68% male) with bicuspid aortic valve presenting to a Canadian congenital cardiac center from 1994 through 2001 and followed up for a mean (SD) period of 9 (5) years. Frequency and predictors of major cardiac events were determined by multivariate analysis. Mortality rate in the study group was compared with age- and sex-matched population estimates.
Main Outcome Measures:
Mortality and cause of death were determined. Primary cardiac events were defined as the occurrence of any of the following complications: cardiac death, intervention on the aortic valve or ascending aorta, aortic dissection or aneurysm, or congestive heart failure requiring hospital admission during the follow-up period.
Results:
During the follow-up period, there were 28 deaths (mean [SD], 4% [1%]). One or more primary cardiac events occurred in 161 patients (mean [SD], 25% [2%]), which included cardiac death in 17 patients (mean [SD], 3% [1%]), intervention on aortic valve or ascending aorta in 142 patients (mean [SD], 22% [2%]), aortic dissection or aneurysm in 11 patients (mean [SD], 2% [1%]), or congestive heart failure requiring hospital admission in 16 patients (mean [SD], 2% [1%]). Independent predictors of primary cardiac events were age older than 30 years (hazard ratio [HR], 3.01; 95% confidence interval [CI], 2.15-4.19; P<.001), moderate or severe aortic stenosis (HR, 5.67; 95% CI, 4.16-7.80; P<.001), and moderate or severe aortic regurgitation (HR, 2.68; 95% CI, 1.93-3.76; P<.001). The 10-year survival rate of the study group (mean [SD], 96% [1%]) was not significantly different from population estimates (mean [SD], 97% [1%]; P = .71). At last follow-up, 280 patients (mean [SD], 45% [2%]) had dilated aortic sinus and/or ascending aorta.
Conclusions:
In this study population of young adults with bicuspid aortic valve, age, severity of aortic stenosis, and severity of aortic regurgitation were independently associated with primary cardiac events. Over the mean follow-up duration of 9 years, survival rates were not lower than for the general population.
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