Differences at surgery between patients with bicuspid and tricuspid aortic valves

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Aortic Valve Pathology

Background:

• Bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) represent distinct aortic valve anatomies.
• Understanding differences in clinical characteristics and surgical procedures between BAV and TAV is crucial for patient management post-aortic valve surgery (AVS).

Purpose of the Study:

• To compare surgical procedures and clinical characteristics at the time of AVS between patients with native BAV and TAV.
• To identify factors associated with BAV versus TAV in patients undergoing AVS.

Main Methods:

• Retrospective cohort study including 439 patients who underwent AVS.
• Patients were categorized into BAV (n=140) and TAV (n=299) groups based on surgeon's reports.
• Multivariable regression analyses were used to identify associations between BAV-TAV and clinical characteristics.

Main Results:

• BAV patients were significantly younger (58.6 vs 69.1 years) and more often male (64% vs 53%) than TAV patients.
• BAV patients exhibited fewer cardiovascular risk factors, including hypertension, hypercholesterolemia, and diabetes.
• Concomitant coronary artery bypass grafting (CABG) was less frequent in BAV patients (14% vs 39%), while proximal aorta surgery was more frequent (31% vs 11%).

Conclusions:

• Mechanical stress is hypothesized as the primary driver for valvulopathy in BAV leading to AVS.
• Prevalent cardiovascular risk factors are suspected drivers for AVS and concomitant CABG in TAV.
• These findings highlight distinct pathophysiological pathways and surgical considerations for BAV and TAV requiring AVS.