Abstract 16739: A Simplified Dichotomous Phenotypic Classification of Bicuspid Aortic Valve Using the Orientation of Coronary Arteries Shows Better Association With Type of Valvulopathy and Combined Aortopathy
Background: Recently introduced dichotomous phenotypic classification of bicuspid aortic valve (BAV) showed potential association between BAV phenotype and patterns of valvulopathy or aortopathy. However its potential advantage needs to be compared with the conventional BAV classification in a large patient population.
Methods: In 486 consecutive patients (309 male, 58±14 years) who underwent aortic valve (AV) surgery (n=483) or aortic surgery (n=146), BAV phenotype was classified using echocardiography. Dichotomous classification was based on the orientation of coronary arteries: AP (both coronary arteries originating from the anterior cusp) and RL (each coronary artery originating from each cusp). Conventional classification (type 1 - 4) was based on the fused cusp (Figure). We analyzed the associations between the BAV phenotype and 1) indication of AV surgery (aortic stenosis [AS] vs. regurgitation [AR]), and 2) implementation of aortic surgery.
Results: BAV-AP (n=271, 56%) was more common than BAV-RL (n=215, 44%). Using conventional classification, fused cusps were indistinguishable in 15% (type 4). Indications of AV surgery included dominant AS (n=352), AR (n=96), and infective endocarditis (IE; n=35). Aortic surgeries were performed for aortic aneurysm (n=135), IE with abscess (n=9), dissection (n=1), and coarctation (n=1). Patients with BAV-RL type presented lower frequency of male (55% vs. 70%, P=0.001), AV surgery for dominant AS (82% vs. 66%, P<0.001), and more frequent aortic surgery (36% vs. 25%, P=0.007) compared to those with BAV-AP. In multivariate analyses, the BAV-RL in dichotomous classification showed more clear association with 1) surgery for dominant AS and 2) aortic surgery compared to the corresponding groups in conventional classification (Figure).
Conclusions: New classification can overcome the ambiguity of the conventional classification and shows better association with type of valvulopathy and combined aortopathy.
Author Disclosures: B. Sun: None. S. Lee: None. J. Jang: None. H. Choi: None. X. Jin: None. J. Lee: None. S. Kang: None. D. Kim: None. J. Song: None. D. Kang: None. J. Song: None.
- © 2015 by American Heart Association, Inc.