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Aortic Stenosis in bicuspid and tricuspid aortic valves are two different scenarios
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  • Maria Celeste Carrero,
  • Gerardo Masson,
  • Ivan Constantin,
  • Martin Ruano,
  • Maria Mezzadra,
  • Carla Pessio,
  • Matias Lopez Rosetti,
  • Gonzalo Diaz Babio,
  • Facundo Veron,
  • Sandra Diaz,
  • Gustavo Stampone,
  • Pablo Stutzbach
Maria Celeste Carrero
Sanatorio Las Lomas SA
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Gerardo Masson
Sanatorio Las Lomas SA
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Ivan Constantin
Sanatorio Las Lomas SA
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Martin Ruano
Sanatorio Las Lomas SA
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Maria Mezzadra
Sanatorio Las Lomas SA
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Carla Pessio
Sanatorio Las Lomas SA
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Matias Lopez Rosetti
Sanatorio Las Lomas SA
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Gonzalo Diaz Babio
Sanatorio Las Lomas SA
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Facundo Veron
Sanatorio Las Lomas SA
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Sandra Diaz
Sanatorio Las Lomas SA
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Gustavo Stampone
Sanatorio Las Lomas SA
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Pablo Stutzbach
Sanatorio Las Lomas SA
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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.