Letter:
To the Editor:
We have reviewed the article entitled “Longer-term outcomes after
bicuspid aortic valve repair in 142 patients” by mojyan safari MD et
al.1 with great enthusiasm. We were fortunate to
review this valuable article which was informative and productive. We
acknowledge the prime conclusion of the study that bicuspid aortic valve
repair is associated with fewer postoperative clinical complications and
the long-lasting durability of the valve. However, few concerns arise,
which masks the findings of the study.
Firstly, conducting a study with having a small number of participants
could alter the authenticity of the study. The authors should have
reflected on taking a large sample size as fewer participants may modify
the study’s findings. For example, a 2011 study decided to include 316
patients to achieve the study’s authenticity.2Secondly, sex differences have also been found to have an impact on the
findings of the study. The author’s in their study have included only
the male sex hence neglecting the female sex. Whereas a 2015 study
highlighted that females tend to have more extended postoperative
hospital stays and receive a maximum number of postoperative blood
products.3
Moreover, as established, smoking is highly associated with increased
chances of contributing to vascular atherosclerotic plaque and
calcification on the aortic valve, which can be a potential reason for
complicated longer outcomes in bicuspid aortic valve repair patients.
Therefore, the authors should have widened their inclusion criteria and
included smoking as one of the participant variables since ignoring
patient characteristics may affect the study’s
outcome.4 Lastly, this single-centered study comes up
with numerous concerns regarding its findings. To overcome this issue,
the authors should have included participants from multiple centers and
locations because of the impact of different races and socioeconomic
populations on the study. For illustration, a 2011 study included
participants from the whole of Olmsted country diagnosed with bicuspid
aortic valve and appear authentic.5
Finally, more studies must be conducted on patients with bicuspid aortic
valves to improve the prognosis and potentially reduce longer-term
complications.