Stentless aortic valve replacement in patients with bicuspid aortic valve disease: clinical outcome and aortic diameter changes during follow-up

Abstract

Objective: A bicuspid aortic valve (BAV) may be associated with an aortopathy affecting clinical outcome. Our aim was to assess long-term outcome and analyse if progressive aortic dilatation occurs with time in patients with BAV disease who underwent stentless valve replacement.

Methods: Demographic, operative and clinical data were retrospectively reviewed. Patients were classified according to whether their native aortic valve was identified as tricuspid (TC) or bicuspid (BC) at the time of AVR. Serial transthoracic echocardiography was used to measure changes in ascending aortic diameter over time. Propensity adjustment and multivariate regression were used. Events over time were assessed using the Kaplan-Meier method, and the determinants of events were assessed with the Cox proportional-hazards model.

Results: Between January 1991 and January 2001, 215 patients underwent AVR. They had a serial follow-up echocardiography performed for a mean of 6.1+/-4.3 years postoperatively. Ninety patients (41%) had a BAV, and the BC group was younger (BC 62+/-15 years vs TC 71+/-12 years; p=0.002). We found no difference in the increase in ascending aortic diameter over follow-up (BC 0.1+/-0.5 cm vs TC 0.0+/-0.5 cm; p=0.34). BC morphology was not an independent predictor of increased overall mortality (propensity-adjusted hazard ratio: 0.79; 95% confidence interval (CI): 0.42-1.44; p=0.44) or increased risk of reoperation (propensity adjusted hazard ration: 1.84; 95% CI: 0.88-3.36; p=0.11).

Conclusion: Stentless AVR is protective against progressive aortic aneurysmal disease and confers excellent clinical outcomes in patients with BAV and normal preoperative ascending aortic diameter.