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Bicuspid aortic valve outcomes

Published online by Cambridge University Press:  12 December 2016

Inês Rodrigues ,
Ana F. Agapito ,
Lídia de Sousa ,
José A. Oliveira ,
Luísa M. Branco ,
Ana Galrinho ,
João Abreu ,
Ana T. Timóteo ,
Sílvia A. Rosa  and
Rui C. Ferreira
Inês Rodrigues*
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Ana F. Agapito
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Lídia de Sousa
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
José A. Oliveira
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Luísa M. Branco
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Ana Galrinho
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
João Abreu
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Ana T. Timóteo
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Sílvia A. Rosa
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Rui C. Ferreira
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
*
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
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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.

Keywords

Aortaaortic valve, bicuspidheart defects, congenitalsurvival
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 518 - 529
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Copyright
© Cambridge University Press 2016 

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References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
2. Ward, C. Clinical significance of the bicuspid aortic valve. Heart 2000; 83: 81–85.Google Scholar
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: 513–515.CrossRefGoogle ScholarPubMed
4. Braverman, AC, Gϋven, H, Beardslee, MA, Makan, M, Kates, AM, Moon, MR. The bicuspid aortic valve. Curr Probl Cardiol 2005; 30: 470–522.CrossRefGoogle ScholarPubMed
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: 1104–1112.Google Scholar
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: 2451–2496.Google ScholarPubMed
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: 777–802.Google Scholar
8. Otto, CM. Textbook of Clinical Echocardiography, 5th edn. Elsevier – Health Sciences Division, Canada, 2013.Google Scholar
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: 1668–1674.Google Scholar
10. Song, JK. Bicuspid aortic valve: unresolved issues and the role of imaging specialists. J Cardiovasc Ultrasound 2015; 23: 1–7.CrossRefGoogle ScholarPubMed
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: 603–606.Google Scholar
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: 744–753.CrossRefGoogle ScholarPubMed
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: 2776–2784.Google Scholar
14. Tzemos, N, Therrien, J, Yip, J, et al. Outcomes in adults with bicuspid aortic valves. JAMA 2008; 300: 1317–1325.Google Scholar
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: 920–925.Google Scholar
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: 821–828.CrossRefGoogle ScholarPubMed
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: 43–46.Google Scholar
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: 35–39.Google Scholar
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: 177–185.Google Scholar
20. Hughes, BR, Chahound, G, Mehta, JL. Aortic stenosis: is it simply a degenerative process or an active atherosclerotic process? Clin Cardiol 2005; 28: 111–114.CrossRefGoogle ScholarPubMed
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: 630–634.Google Scholar
22. Carabello, BA. Evaluation and management of patients with aortic stenosis. Circulation 2002; 105: 1746–1750.CrossRefGoogle ScholarPubMed
23. Ward, C. Clinical significance of the bicuspid aortic valve. Heart 2000; 83: 81–85.Google Scholar
24. Tornos, P, Iung, B, Permanyer-Miralda, G, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 2005; 91: 571–575.Google Scholar
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: 1723–1729.Google Scholar
26. Michela, HI, Khanna, AD, Mahoney, D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA, 306: 1104–1112.Google Scholar
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: 126–134.Google Scholar
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: 223–226.Google Scholar