Later aorta operation after aortic valve replacement for bicuspid aortic valve

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Bicuspid Aortic Valve Disease

Background:

• Bicuspid aortic valve (BAV) is a common congenital heart defect.
• Aortic valve replacement (AVR) is a standard treatment for symptomatic BAV.
• Long-term outcomes after isolated AVR for BAV require further investigation.

Purpose of the Study:

• To evaluate long-term outcomes after isolated AVR in patients with BAV.
• To identify risk factors for later aortic operations and overall death.
• To assess the safety of isolated AVR in BAV patients without concomitant aortic surgery.

Main Methods:

• Retrospective analysis of 181 patients who underwent isolated AVR for BAV between 2002 and 2022.
• Median follow-up of 6.1 years with 97.8% completion rate.
• Competing risk regression models (Fine-Gray and Cox) were used to analyze outcomes.

Main Results:

• Only 3 patients (1.7%) required later aortic operations.
• The 10-year cumulative incidence of later aortic operations was 16.3%.
• Aortic valve stenosis predicted later aortic operations (HR 8.477) and overall death (HR 8.270). Operation time also predicted overall death (HR 1.011).

Conclusions:

• Isolated AVR for BAV in patients with ascending aortic diameter <45 mm is associated with a low risk of subsequent aortic surgery.
• Aortic valve stenosis is a significant risk factor for adverse aortic events and mortality post-isolated AVR.
• Careful patient selection and monitoring are crucial for managing BAV.