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Bicuspid versus tricuspid aortic valve morphology in elective ascending aortic aneurysm surgery: A propensity
Adam Ryszard Kowalówka1,2, Mikołaj Jodłowski1,2, Ryszard Bachowski1,2
1Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland.
Objective:
To compare perioperative and long-term outcomes between bicuspid (BAV) and tricuspid (TAV) aortic valve patients undergoing elective ascending aortic aneurysm surgery using propensity score matching (PSM).
Methods:
We retrospectively analyzed 1340 consecutive adults who underwent elective ascending aortic surgery for aneurysm at a single high-volume center between January 2014 and December 2025. After exclusions, 816 patients (373 BAV, 443 TAV) were eligible. PSM (1:1 nearest-neighbor, caliper width 0.2 SD on the logit scale; 14 baseline covariates, including ascending aortic diameter) produced 285 matched pairs (all with standardized mean difference <0.10). Primary endpoints were 30-day and 10-year all-cause mortality; secondary endpoints included early postoperative complications and late aortic reintervention.
Results:
The median follow-up was 5.4 years (interquartile range, 2.6-8.1; completeness, 96.7%). Thirty-day mortality was 0.7% (n = 2 of 285) in the BAV group versus 1.05% (n = 3 of 285) in the TAV group (odds ratio, 0.66; 95% confidence interval, [CI], 0.11-3.98; P = 1.00). Ten-year survival was 61.4% (95% CI, 55.8%-67.1%) in the BAV group versus 57.9% (95% CI, 52.2%-63.6%) in the TAV group (log-rank χ2 = 2.39; df = 1; P = .31). Early postoperative complications did not differ between the 2 groups (all P > .05). The cumulative incidence of late aortic reintervention at 10 years was 4.6% (95% CI, 2.1%-8.5%) in the BAV group versus 3.5% (95% CI, 1.4%-7.0%) in the TAV group (Gray test, P = .57). In multivariable Cox regression, BAV morphology was not an independent predictor of mortality (hazard ratio, 0.92; 95% CI, 0.58-1.45; P = .74).
Conclusions:
In this propensity score-matched cohort, BAV morphology was not associated with worse perioperative or long-term outcomes after elective ascending aortic surgery compared to TAV. These findings support managing BAV-related aortopathy according to the same patient- and anatomy-driven principles used for TAV rather than based on valve morphology alone.
