Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves

Masri, Ahmad; Kalahasti, Vidyasagar; Alkharabsheh, Saqer; Svensson, Lars G.; Sabik, Joseph F.; Roselli, Eric E.; Hammer, Donald; Johnston, Douglas R.; Collier, Patrick; Rodriguez, L. Leonardo; Griffin, Brian P.; Desai, Milind Y.

doi:10.1016/j.jtcvs.2015.12.019

Cited by 86 publications

(69 citation statements)

References 28 publications

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“…Few studies have reported on moderate to severe AR prevalence in BAV,6–8 12–14 but those showed a varied prevalence between 13% and 32%, probably representing community cohorts versus referral bias in the tertiary care settings. AR tends to present at a younger age when compared with AS, with a mean age around 45 years (vs 54 years for significant AS) 8. In a recent study of 1417 mostly asymptomatic patients (37% with BAV) with ≥III+ AR, there was significantly improved long-term survival following AV surgery, similar to that of an age-matched and gender-matched population 23…”

Section: Resultsmentioning

confidence: 89%

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Contemporary natural history of bicuspid aortic valve disease: a systematic review

Masri

Svensson

Griffin

et al. 2017

Heart

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167

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We performed a systematic review of the current state of the literature regarding the natural history and outcomes of bicuspid aortic valve (BAV). PubMed and the reference lists of the included articles were searched for relevant studies reporting on longitudinal follow-up of BAV cohorts (mean follow-up ≥2 years). Studies limited to patients undergoing surgical interventions were excluded. 13 studies (11 502 patients with 2-16 years of follow-up) met the inclusion criteria. There was a bimodal age distribution (30-40 vs ≥50 years), with a 3:1 male to female ratio. Complications included moderate to severe aortic regurgitation (prevalence 13%-30%), moderate to severe aortic stenosis (12%-37%), infective endocarditis (2%-5%) and aortic dilatation (20%-40%). Aortic dissection or rupture was rare, occurring in 38 patients (0.4%, 27/6446 in native BAV and 11/2232 in post). With current aggressive surveillance and prophylactic surgical interventions, survival in three out of four studies was similar to that of a matched general population. In this systematic review, valvular dysfunction warranting surgical intervention in patients with BAV were common, aortic dissection was rare and, with the current management approach, survival was similar to that of the general population.

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Section: Resultsmentioning

confidence: 89%

“…Significant mixed AS and AR developed only in 1% of the patients in the study by Michelena et al 6 and was present in 3% of the patients in the study by Masri et al 8. Another recent study evaluated the outcomes of 251 patients with mixed moderate AS and AR, of which 38% had BAV 28.…”

Section: Resultsmentioning

confidence: 96%

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Masri

Svensson

Griffin

et al. 2017

Heart

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167

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“…Indeed, as demonstrated by the results of the current study and others pertaining to complex aortic root and ascending aortic surgeries, the most appropriate option would be to offer this only at high-volume experienced centers that have demonstrated excellent surgical outcomes, after shared decision making. 10,[36][37][38][39][40][41] These findings need prospective validation, especially in patients with an isolated BAV aortopathy.…”

Section: Discussionmentioning

confidence: 99%

“…9,14,17 On the contrary, prior data have suggested that ≈40% patients (including patients with BAV aortopathy) have an aortic diameter <5 cm at the time of presentation with type A dissection. 18 Furthermore, absolute aortic diameter cutoffs have inherent limitations, including failure to account for size/height, sex, 19,20 and irregular elliptical shape of the aorta (frequently observed in BAV 1,10 ). Therefore, previous reports have suggested indexing aortic dimensions using either body surface area (BSA) or height.…”

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confidence: 99%

Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta

Masri

Kalahasti

Svensson

et al. 2017

Circ: Cardiovascular Imaging

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Background— In patients with bicuspid aortic valve and dilated proximal ascending aorta, we sought to assess (1) factors associated with increased longer-term cardiovascular mortality and (2) incremental prognostic use of indexing aortic root to patient height. Methods and Results— We studied 969 consecutive bicuspid aortic valve patients (50±13 years; 87% men) with proximal aorta ≥4 cm, who also had a gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography. A ratio of ascending aortic area/height was calculated on tomography, and ≥10 cm 2 /m was considered abnormal, as previously reported. Society of Thoracic Surgeons score and cardiovascular death were recorded. Greater than or equal to III+ aortic regurgitation and severe aortic stenosis were seen in 37% and 10%, respectively. Society of Thoracic Surgeons score and right ventricular systolic pressure were 2±3 and 15±16 mm Hg, respectively. Abnormal ascending aortic area/height ratio was noted in 33%; 44% underwent ascending aortic surgery at 34 days. At 10.8 years (interquartile range, 9.6–12.3), 82 (9%) died (0.4% in-hospital postoperative mortality). On multivariable Cox survival analysis, ascending aortic area/height ratio (hazard ratio, 2; 95% confidence interval, 1.20–3.35) was associated with cardiovascular death, whereas aortic surgery (hazard ratio, 0.46; confidence interval, 0.26–0.80) was associated with improved survival (both P <0.01). Of the 405 patients with ascending aortic diameter of 4.5 to 5.5 cm, 64% had an abnormal ascending aortic area/height ratio, and 70% deaths occurred in patients with an abnormal ratio. Conclusions— In bicuspid aortic valve patients with dilated proximal ascending aorta, ascending aortic area/height ratio was independently associated with cardiovascular death.

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“…Показатели выживаемости в отдаленном периоде в ФГБНУ «НИИ КПССЗ» сопоставимы с данными зару-бежной литературы [9][10][11][12].…”

Section: показатели выживаемости в группе механических и биологическиunclassified

20-year experience of surgical correction of isolated aortic valve disease

Барбараш¹,

Рогулина²,

Кокорин³

et al. 2016

Kardiol. serdechno-sosud. khir.

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Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves

Abstract: Patients with BAV have a high prevalence of AV dysfunction and concomitant aortopathy. Undergoing surgery (AV replacement and/or repair ± AAR) was associated with a significantly lower incidence of death and/or dissection.

Cited by 86 publications

References 28 publications

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta

20-year experience of surgical correction of isolated aortic valve disease

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