Bicuspid and Unicuspid Aortic Valve: Fate of Moderate/Severe Mixed Aortic Valve Disease. (4th July 2016)

• Record Type: Journal Article
• Authors: Egbe, Alexander C.; Connolly, Heidi M.; Poterucha, Joseph T.; Warnes, Carole A.
• Is Part Of: Congenital heart disease. Volume 12:Number 1(2017)
• Page Start: 24
• Page End: 31
• Publication Date: 2016-07-04
• Subjects: Bicuspid Valve -- Aortic Stenosis -- Aortic Regurgitation -- Aortic Valve Replacement; Congenital heart disease -- Periodicals; 616.1204305
• DOI: 10.1111/chd.12391
• Languages: English
• ISSNs: 1747-079X

Abstract

Abstract: Objectives: There is a paucity of data about mixed aortic valve disease (MAVD) in patients with bicuspid/unicuspid aortic valve (BAV). This study sought to describe the outcomes of patients with moderate/severe MAVD. Methods: We queried our database for patients with BAV and moderate/severe MAVD seen between 1994 and 2013. We excluded patients with baseline New York Heart Association (NYHA) III/IV symptoms, left ventricular ejection fraction <50%, aortic dimension >50 mm, and significant disease of other valves. The purpose of the study was to determine the freedom from NYHA III/IV symptoms and aortic valve replacement (AVR). Results: We identified 138 patients with moderate/severe MAVD; mean age was 51 ± 12 years; 112 (81%) were males; and follow‐up was 8.5 ± 4 years. Ninety‐two patients (67%) underwent AVR within 3.7 ± 2.5 years. Mechanical prostheses were implanted in 73 patients (79%); 22 patients (26%) and 36 patients (39%) had concomitant coronary artery bypass graft and aorta replacement during AVR respectively. There were no surgical deaths. Freedom from AVR was 84%, 51%, and 20% at 1, 5 and 10 years respectively. Predictors of AVR were age at presentation (hazard ratio [HR] 5.22; confidence interval [CI] 3.10 to 6.64) for every decade increase in age; and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16). Conclusions: Age and disease severity should be incorporated in the risk assessment of BAV patients with MAVD, and patients with both risk factors should be monitored closely.