Abstract 13002: Characteristics and Long-Term Outcomes of Patients With Bicuspid Aortic Valve: Impact of Cardiovascular Surgery
Background: We sought to a) understand characteristics & long-term outcomes of a contemporary group of patients with bicuspid aortic valve (BAV) +/- aortopathy & b) determine if surgery for BAV improves hard outcomes.
Methods: We studied 1896 consecutive patients with BAV (age 50±14 years, 75% men) that underwent initial evaluation between 2003-2007, at a tertiary-care center. Baseline clinical, echocardiographic, chest tomography, surgical & outcomes data was recorded. Euroscore was calculated. Endpoint was a composite of death or aortic dissection.
Results: Mean left ventricular ejection fraction (LVEF), aortic root size & Euroscore were 55±8 %, 3.6±0.8 cm and 4±2. 671 (35%) patients had aortic root ≥4 cm, 30% had ≥III+ aortic regurgitation (AR) & 10% had mean AV gradient ≥40 mm Hg. At 8±2 years of follow-up, 924 (49%) patients underwent surgery related to BAV [884 AV replacement (+/- combination procedures) and 470 (25%) with ascending aortic grafting] & there were 177 (9%) events (8 dissections). Median time from evaluation to surgery was 30 days [4-465 days]. On multivariable Cox Proportional Survival Analysis, increasing age (Hazard ratio or HR 1.06 [1.04-1.07]), increasing aortic root size (HR 1.32 [1.06-1.64]), decreasing LVEF (HR 1.04 [1.03-1.05]) & hyperlipidemia (HR 1.50 [1.20-1.88]) predicted higher event rate, while surgery related to BAV (time-dependent covariate HR 0.49 [0.34-0.70]) improved survival (all p<0.001). Figure shows Kaplan-Meier curves based on surgery. Addition of BAV surgery to the clinical model (Euroscore, AR & mean AV gradient), improved risk stratification for events (c-statistic increased from 0.66 [0.62-0.71] to 0.72 [0.66-0.74], p-value 0.02).
Conclusion: BAV patients have a varied presentation with a high prevalence of concomitant aortopathy, which predicted worse survival. Surgery (AV replacement +/- ascending aortic replacement) was associated with significantly improved freedom from death/dissection.
Author Disclosures: A. Masri: None. V. Kalahasti: None. S. Alkharabsheh: None. J.F. Sabik: None. P. Collier: None. L.G. Svensson: None. L. Rodriguez: None. B.W. Lytle: None. B.P. Griffin: None. M.Y. Desai: None.
- © 2014 by American Heart Association, Inc.