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 and
echocardiographic characteristics, with lower overall mortality and a
more advanced AS when requiring aortic valve intervention.