Skip to main content
×
×
Home

Bicuspid aortic valve outcomes

  • Inês Rodrigues (a1), Ana F. Agapito (a1), Lídia de Sousa (a1), José A. Oliveira (a1), Luísa M. Branco (a1), Ana Galrinho (a1), João Abreu (a1), Ana T. Timóteo (a1), Sílvia A. Rosa (a1) and Rui C. Ferreira (a1)...
Abstract
Abstract Background

Bicuspid aortic valve is the most common CHD. Its association with early valvular dysfunction, endocarditis, thoracic aorta dilatation, and aortic dissection is well established.

Objective

The aim of this study was to assess the incidence and predictors of cardiac events in adults with bicuspid aortic valve.

Methods

We carried out a retrospective analysis of cardiac outcomes in ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre. Outcomes were defined as follows: interventional – intervention on the aortic valve or thoracic aorta; medical – death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission; and a composite end point of both. Kaplan–Meier curves were generated to determine event rates, and predictors of cardiac events were determined by multivariate analysis.

Results

A total of 227 patients were followed-up over 13±9 years; 29% of patients developed severe aortic valve dysfunction and 12.3% reached ascending thoracic aorta dimensions above 45 mm. At least one cardiac outcome occurred in 38.8% of patients, with an incidence rate at 20 years of follow-up of 47±4%; 33% of patients were submitted to an aortic valve or thoracic aorta intervention. Survival 20 years after diagnosis was 94±2%. Independent predictors of the composite end point were baseline moderate–severe aortic valve dysfunction (hazard ratio, 3.19; 95% confidence interval, 1.35–7.54; p<0.01) and aortic valve leaflets calcification (hazard ratio, 4.72; 95% confidence interval, 1.91–11.64; p<0.005).

Conclusions

In this study of bicuspid aortic valve, the long-term survival was excellent but with occurrence of frequent cardiovascular events. Baseline aortic valve calcification and dysfunction were the only independent predictors of events.

Copyright
Corresponding author
Correspondence to: I. Rodrigues, MD, Department of Cardiology, Hospital de Santa Marta, Rua de Santa Marta, no. 50, 1169-024 Lisbon, Portugal. Tel: +351 21 359 4000/+351 91 723 6667; E-mail: inesgoncalvesrodrigues@gmail.com
References
Hide All
1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 18901900.
2. Ward C. Clinical significance of the bicuspid aortic valve. Heart 2000; 83: 8185.
3. Tutar E, Ekici F, Atalay S, Nacar N. The prevalence of bicuspid aortic valve in newborns by echocardiographic screening. Am Heart J 2005; 150: 513515.
4. Braverman AC, Gϋven H, Beardslee MA, Makan M, Kates AM, Moon MR. The bicuspid aortic valve. Curr Probl Cardiol 2005; 30: 470522.
5. Michelena HI, Prakash SK, Della Corte A, et al. Bicuspid aortic valve: identifying knowledge gaps and rising to the challenge from the International Bicuspid Aortic Valve Consortium (BAVCon). Circulation 2014; 129: 11041112.
6. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 24512496.
7. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16: 777802.
8. Otto CM. Textbook of Clinical Echocardiography, 5th edn. Elsevier – Health Sciences Division, Canada, 2013.
9. Eleid MF, Forde I, Edwards WD, et al. Type A aortic dissection in patients with bicuspid aortic valves: clinical and pathological comparison with tricuspid aortic valves. Heart 2013; 99: 16681674.
10. Song JK. Bicuspid aortic valve: unresolved issues and the role of imaging specialists. J Cardiovasc Ultrasound 2015; 23: 17.
11. Rich S, Sheikh A, Gallastegui J, Kondos GT, Mason T, Lam W. Determination of left ventricular ejection fraction by visual estimation during real-time two-dimensional echocardiography. Am Heart J 1982; 104: 603606.
12. Quinones MA, Waggoner AD, Reduto LA, et al. A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 1981; 64: 744753.
13. Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation 2008; 117: 27762784.
14. Tzemos N, Therrien J, Yip J, et al. Outcomes in adults with bicuspid aortic valves. JAMA 2008; 300: 13171325.
15. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation 2005; 111: 920925.
16. Thanassoulis G, James Y, Filion K, et al. Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves. Nat Clin Pract Cardiovasc Med 2008; 5: 821828.
17. Ferencik M, Pape LA. Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves. Am J Cardiol 2003; 92: 4346.
18. Keane MG, Wiegers SE, Plappert T, Pochettino A, Bavaria JE, Sutton MG. Bicuspid aortic valves are associated with aortic dilation out of proportion to coexistent valvular lesions. Circulation 2000; 102: 3539.
19. Robicsek F, Thubrikar MJ, Cook JW, Fowler B. The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg 2004; 77: 177185.
20. Hughes BR, Chahound G, Mehta JL. Aortic stenosis: is it simply a degenerative process or an active atherosclerotic process? Clin Cardiol 2005; 28: 111114.
21. Stewart BF, Siscovick D, Lind B, et al. Clinical factors associated with calcific aortic valve disease: Cardiovascular Health Study. J Am Coll Cardiol 1997; 29: 630634.
22. Carabello BA. Evaluation and management of patients with aortic stenosis. Circulation 2002; 105: 17461750.
23. Ward C. Clinical significance of the bicuspid aortic valve. Heart 2000; 83: 8185.
24. Tornos P, Iung B, Permanyer-Miralda G, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 2005; 91: 571575.
25. Tribouilloy C, Rusinaru D, Sorel C, et al. Clinical characteristics and outcome of infective endocarditis in adults with bicuspid aortic valves: a multi-centre observational study. Heart 2010; 96: 17231729.
26. Michela HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA, 306: 11041112.
27. Detaint D, Michelena HI, Nkomo VT, Vahanian A, Jondeau G, Sarano ME. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy. Heart 2014; 100: 126134.
28. Ocak I, Lacomis JM, Deible CR, Pealer K, Parag Y, Knollmann F. The aortic root: comparison of measurements from ECG-gated CT angiography with transthoracic echocardiography. J Thorac Imaging 2009; 24: 223226.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 19
Total number of PDF views: 110 *
Loading metrics...

Abstract views

Total abstract views: 414 *
Loading metrics...

* Views captured on Cambridge Core between 12th December 2016 - 18th January 2018. This data will be updated every 24 hours.