Contemporary differences between bicuspid and tricuspid aortic valve in chronic aortic regurgitation

Published on Oct 25, 2020in Heart5.213
· DOI :10.1136/HEARTJNL-2020-317466
Li Tan Yang11
Estimated H-index: 11
Li-Tan Yang1
Estimated H-index: 1
(NTU: National Taiwan University)
+ 6 AuthorsHector I. Michelena47
Estimated H-index: 47
(Mayo Clinic)
Objective To comprehensively explore contemporary differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with chronic haemodynamically significant aortic regurgitation (AR). Methods Consecutive patients with chronic ≥moderate-severe AR from a tertiary referral centre (2006–2017) were included. All-cause mortality, surgical indications and aortic valve surgery (AVS) were analysed. Results Of 798 patients (296 BAV-AR, age 46±14 years; 502 TAV-AR, age 67±14 years, p 20 mm/m2; similar thresholds were observed for BAV-AR patients. Conclusion BAV-AR patients were two decades younger than TAV-AR and underwent AVS more frequently, resulting in a considerable real-life survival advantage for BAV-AR that was determined primarily by age and not valve anatomy. Pragmatically, regardless of valve anatomy, patients with haemodynamically significant AR and age >50–55 years require a low-threshold for surgical referral to prevent symptom development where LVEF 20 mm/m2 seem appropriate referral thresholds.
#1Li-Tan YangH-Index: 1
#1Li Tan YangH-Index: 11
Last. Hector I. MichelenaH-Index: 47
view all 6 authors...
The most common complication of patients with bicuspid aortic valve (BAV) is aortic valve surgery ([1][1]). Hemodynamically significant (moderate-severe to severe) aortic regurgitation (AR) is more common in younger men with BAV ([1][1]) and is classified as Stage C (asymptomatic) or D (symptomatic
4 CitationsSource
#1Li Tan Yang (Mayo Clinic)H-Index: 11
#2Patricia A. Pellikka (Mayo Clinic)H-Index: 101
Last. Hector I. Michelena (Mayo Clinic)H-Index: 47
view all 8 authors...
Abstract Background The prognostic significance of diastolic blood pressure (DBP) and resting heart rate (RHR) in patients with hemodynamically significant aortic regurgitation (AR) is unknown. Objectives This study sought to investigate the association of DBP and RHR with all-cause mortality in patients with AR. Methods Consecutive patients with ≥ moderate to severe AR were retrospectively identified from 2006 to 2017. The association between all-cause mortality and routinely measured DBP and R...
8 CitationsSource
#1Li-Tan Yang (Mayo Clinic)H-Index: 1
#1Li-Tan Yang (Mayo Clinic)H-Index: 1
Last. Patricia A. Pellikka (Mayo Clinic)H-Index: 101
view all 5 authors...
Abstract Objective To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). Patients and Methods Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. Results Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%...
8 CitationsSource
#1Christophe de Meester (Cliniques Universitaires Saint-Luc)H-Index: 15
#2Bernhard Gerber (Cliniques Universitaires Saint-Luc)H-Index: 60
Last. Jean-Louis Vanoverschelde (UCL: Université catholique de Louvain)H-Index: 84
view all 9 authors...
Abstract Objectives The present study examines whether improvements have reduced the negative impact of guideline triggers on postoperative outcomes. Background European and American guidelines for the management of severe aortic regurgitation (AR) define the triggers for AR surgery. These triggers are based on the results of studies performed in the 1990s analyzing outcomes of patients who underwent AR surgery in the 1980s. Although these triggers are used to indicate surgery, they have all bee...
19 CitationsSource
#1Arturo EvangelistaH-Index: 61
#1Arturo Evangelista (Ciber)H-Index: 13
Last. David García-Dorado (Ciber)H-Index: 7
view all 15 authors...
Objective Bicuspid aortic valve (BAV) is associated with early valvular dysfunction and proximal aorta dilation with high heterogeneity. This study aimed to assess the determinants of these complications. Methods Eight hundred and fifty-two consecutive adults diagnosed of BAV referred from cardiac outpatient clinics to eight echocardiographic laboratories of tertiary hospitals were prospectively recruited. Exclusion criteria were aortic coarctation, other congenital disorders or intervention. BA...
29 CitationsSource
#1Takashi Murashita (Mayo Clinic)H-Index: 14
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 128
view all 8 authors...
Background The timing of valve repair or replacement in patients with severe aortic valve regurgitation (AR) is controversial. We investigated the effect of left ventricular (LV) function on survival and recovery of LV performance and dimensions after correction of chronic severe AR. Methods We reviewed 530 consecutive patients who underwent aortic valve repair or replacement for severe AR between January 1, 2004, and June 30, 2014. Results The 30-day mortality was 0.75%. In multivariate analysi...
12 CitationsSource
#1William A. Zoghbi (Houston Methodist Hospital)H-Index: 67
#2David H. Adams (Duke University)H-Index: 53
Last. Neil J. Weissman (MedStar Health)H-Index: 25
view all 16 authors...
940 CitationsSource
#1Ulrich Schneider (Saarland University)H-Index: 10
#2Susanne K. Feldner (Saarland University)H-Index: 4
Last. Hans-Joachim Schäfers (Saarland University)H-Index: 69
view all 7 authors...
Abstract Objective Bicuspid aortic valve anatomy is associated with ascending aortic aneurysm in approximately 50% of individuals and may lead to severe aortic regurgitation with aortic dilatation. Both entities may be treated by valve repair and root remodeling. The objective was to review the cumulative experience of 20 years. Methods Between November 1995 and December 2015, 357 patients (324 male; age 10-80 years; mean, 49 ± 13 years) underwent combined bicuspid aortic valve repair and root r...
63 CitationsSource
#1Hector I. Michelena (Mayo Clinic)H-Index: 47
#2Siddharth K. Prakash (University of Texas Health Science Center at Houston)H-Index: 27
Last. Simon C. Body (Harvard University)H-Index: 51
view all 18 authors...
> Everything should be kept as simple as possible, but no simpler. > > —Albert Einstein1 Since its estimated first description >500 years ago by Leonardo da Vinci,2 the bicuspid aortic valve (BAV) has progressively built a reputation; initially, as a curious valvular phenotype with a tendency to develop obstruction and insufficiency. In more contemporary times, however, the BAV is recognized as underlying almost 50% of isolated severe aortic stenosis cases requiring surgery,3 and has been extens...
210 CitationsSource
#1Rick A. Nishimura (Mayo Clinic)H-Index: 128
#2Catherine M Otto (UW: University of Washington)H-Index: 85
Last. James D. Thomas (Cleveland Clinic)H-Index: 87
view all 12 authors...
The medical profession should play a central role in evaluating evidence related to drugs, devices, and procedures for detection, management, and prevention of disease. When properly applied, expert analysis of available data on the benefits and risks of these therapies and procedures can improve
2,505 CitationsSource
Cited By0