Differences at surgery between patients with bicuspid and tricuspid aortic valves

Cozijnsen, Luc; Zaag-Loonen, Hester J. van der; Cozijnsen, Martinus A.; Braam, Richard L.; Heijmen, Robin H.; Bouma, Berto J.; Mulder, Barbara J.M.

doi:10.1007/s12471-018-1214-1

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…The relationship of CAD and the aortic valve morphology and a possible atheroprotective effect of BAV is a topic of ongoing debate. [5][6][7][8] Previous studies have shown a significantly larger aortic valve calcium volume in BAV patients than TAV patients, 5 but strikingly a lower prevalence of cardiovascular risk factors, coronary calcification, CAD and coronary revascularisation. 3 6-8 These observations imply that the aortic valve calcifications in BAV disease merely reflect local degenerative changes rather than systemic atherosclerotic changes.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective

et al. 2021

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ObjectiveBicuspid aortic valve (BAV) has been associated with less atherosclerosis as compared with tricuspid aortic valve (TAV) patients. It, however, remains unclear whether this reflects the older age of TAV patients and/or accumulation of atherosclerotic risk factors or that the BAV phenotype is atheroprotective. Therefore, we compared the atherosclerotic disease burden of BAV and TAV patients, with that of the general (age-matched) population.MethodsThe prevalence of coronary artery disease (CAD) and CAD risk factors in BAV and TAV patients who underwent aortic valve surgery were compared with the Dutch general practitioners registry data. BAV (n=454) and TAV (n=1101) patients were divided into four groups: BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS) and TAV with AR (TAV-AR). The atherosclerotic disease burden of each group was compared with that of the corresponding age cohort for the general population.ResultsCAD risk factors hypertension and hypercholesterolaemia were more prevalent in the surgery groups than the age-matched general population (all p<0.001). All BAVs (BAV-AoS and BAV-AR) and TAV-AR had a similar incidence of CAD history as compared to the age-matched general populations (p=0.689, p=0.325 and p=0.617 respectively), whereas TAV-AoS had a higher incidence (21.6% versus 14.9% in the age-matched general population, p<0.001).ConclusionsStenotic TAV disease is part of the atherosclerotic disease spectrum, while regurgitant TAV and all BAVs are not. Although the prevalence of cardiovascular risk factors is higher in all BAV patients, the prevalence of CAD is similar to the general population.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective

et al. 2021

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“…BAV may be present in up to 30% of patients undergoing SAVR. 32 Bicuspid aortic valve anatomy, larger annular size, bulky and asymmetric leaflet calcification and dilated ascending aorta all pose technical challenges to TAVI which are not prohibitive risk factors for surgery. In fact, associated pathology of aneurysms of the aortic root and ascending aorta can be treated at the time of SAVR with little additional risk.…”

Section: Discussionmentioning

confidence: 99%

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

et al. 2021

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ObjectivesTo date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.DesignRetrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.Setting27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.Participants31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.ResultsIn-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.ConclusionsSurgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.

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“…Thirty-five studies 7,12,13,[17][18][19][20][21][22][23][24][25][26]28,29,[31][32][33][34]36,39,40,[45][46][47][48][49][50][51]53,[55][56][57][58][59]…”

Section: Diabetes Mellitusmentioning

confidence: 99%

The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature

Dolmaci,

Hilhorst,

Malekzadeh

et al. 2023

Aorta (Stamford)

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The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.

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Differences at surgery between patients with bicuspid and tricuspid aortic valves

Cited by 8 publications

References 28 publications

Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective

Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature

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