Aortic Stenosis in bicuspid and tricuspid aortic valves are two
different scenarios
Abstract
Patients with bicuspid aortic valve (BAV) represent a significant
proportion of adults with severe aortic stenosis (AS) requiring aortic
valve intervention (AVI). Evidence is discordant concerning progression
of AS in BAV. The aim of this study was to compare baseline
characteristics and the impact of the aortic valve phenotype on major
cardiovascular outcomes. Methods: Retrospective observational study
(consecutive AS in database, 2014-2016, third-level institution).
Baseline characteristics were compared between BAV (n = 43) and
tricuspid (TAV) (n = 159) patients. Primary end point was a composite of
mortality and AVI. Survival analysis and logistic regression analysis
was used to identify predictors of primary end-point. Results: 202
patients (72.2 ± 13.4 years, 63% men) were included. Patients with TAV
were older, had more comorbidities and less aorta dilation. No
significant differences were observed in the primary end point between
the two valve phenotypes (34.8 vs. 40.8%; p=0.47, follow-up of 3.2 ±
1.6 years). In BAV group most of the events were at the expense of AVI
(32.5 vs. 13.8%; p=0.001). The incidence of CV death was similar
between both groups (4.8% vs. 12%, p=0.25). Non-CV mortality was
higher in TAV group (16.8% vs 0%, p=0.001). Vmax and dimensionless
index were independently associated with primary end point
(p<0.001). Conclusions: Patients with AS have a high incidence
of all-cause mortality and aortic valve intervention, regardless of
valve phenotype. In particular, patients with BAV present different
clinical characteristics with lower overall mortality and a more
advanced AS when requiring aortic valve intervention.