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Later aorta operation after aortic valve replacement for bicuspid aortic valve

Kohei Hachiro1, Noriyuki Takashima2, Tomoaki Suzuki2

  • 1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, 520-2192, Shiga, Japan. starplatinum.1140@gmail.com.

Journal of Cardiothoracic Surgery
|March 20, 2024
PubMed

Insights

Patients with bicuspid aortic valve (BAV) undergoing aortic valve replacement without concurrent aortic surgery have a low risk of later aortic operations. Aortic valve stenosis is a predictor for both later aortic operations and overall death in these patients.

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.
Abstract

Keywords:
Aortic valve replacementBicuspid aortic valveLater aorta operation

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