Bicuspid aortic valve disease: systematic review and meta-analysis of surgical aortic valve repair

Abstract

Aortic valve repair is still emerging, and its role in the treatment of bicuspid aortic valve disease (BAVD) is not yet fully understood. Our objective is to synthesise available evidence on outcomes after surgical aortic valve repair in patients with BAVD. We conducted a systematic review of clinical studies using prespecified methods for searching, identifying and selecting eligible studies in 4 databases, and synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers independently reviewed full-text articles and extracted data. The results of included studies were quantitatively synthesised in frequentist meta-analyses. We included 11 aortic valve repair studies or study arms with a total of 2010 participants. Pooled estimates for the proportion of patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995 (95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993) and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean follow-up of 3.5 years. Proportion of patients with valve-related reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9 years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100 patient-years. Outcome reporting was insufficient to pool the results for a number of predefined outcomes. In conclusion, existing evidence on aortic valve repair in BAVD is limited to mostly small case series, case–control and small retrospective cohort studies. Despite the low quality, available evidence suggests favourable survival outcomes after aortic valve repair in selected patients with BAVD. Valve-related reinterventions at follow-up are common in all patients undergoing repair surgery.

Bicuspid aortic valve repair: systematic review on long-term outcomes

“…Salcher et al conducted a pooled analysis on the subject in 2016 with from 11 separate studies reporting on patients undergoing BAV repair (39). The mean age was 45.3 years with strong male preponderance (82.1%).…”

Aortic valve repair or replacement in patients with aortic regurgitation: A systematic review and meta‐analysis

“…There have been limitations to current evidence that compares outcomes of patients receiving aortic repair or replacement for AR. As the major portion of literatures focuses mainly on the individual outcomes of either valve repair or replacement at separate studies than comparing them in the same cohort . This study adds important value to current evidence through directly comparing the surgical outcomes of AVr and AVR in the background of AR.…”

“…Different techniques have been applied to different aortic valvular pathologies . The American Heart Association/American College of Cardiology Guidelines for the management of patients with valvular heart disease stated that AVr lacks the uniform applicability and widespread experience with surgical techniques; therefore, the applicability of valve repair is varying from one center to another.…”

“…Several of the included studies focused on patients with bicuspid aortic valve disease (BAVD), a disease entity which surgeons paid increasing efforts into; whereas others do comprise of patients with a multitude of aetiologies giving rise to chronic AR . Although BAVD can be a key contributing factor to the development of AR; limiting the work to this subpopulation will only underpower the results and the reported outcomes due to small sample size and limited reported outcomes.…”

“…This may be a justification for expanding the use of AVr, despite being a technically demanding procedure when compared with the more mature AVR. This is possibly contributed by the learning effect and the improving techniques throughout the decades …”