Secció de Cardiologia. Hospital Universitari de Sant Joan. Institut d'Investigació Sanitària Pere Virgili. Universitat Rovira i Virgili, Reus, Spain.
Int J Med Sci. 2013;10(2):176-82. doi: 10.7150/ijms.5399. Epub 2013 Jan 9.
Bicuspid aortic valve (BAV) increases the risk of aortic valve dysfunction and ascending aorta aneurysm and, consequently, the need for aortic valve replacement and/or aortic repair. However, there is no universal consensus about the surgical criteria and the predictors for surgery. The aim of this study was to investigate related factors to the need for surgery in the setting of a strict long-term follow-up with relatively conservative surgical criteria.
We prospectively followed 120 patients after the diagnosis of BAV. Predisposing factors for a future need for aortic valve replacement and ascending aorta repair were assessed. Aortic surgery was indicated when the ascending aorta diameter was ≥ 55 mm and was recommended based on patient characteristics and in the presence of a severe aortic valve dysfunction with an aortic diameter ≥ 50 mm.
During follow-up (mean, 86 months), 34 patients (28%) (mean age, 56 ± 12 years) were surgically treated. Aortic valve dysfunction (n=22; 64%) and ascending aorta dilatation (n=12; 36%) were the indications for surgery. Aortic regurgitation was the most frequent valve dysfunction at the time of diagnosis for BAV, but aortic stenosis was the most frequent indication for surgery. The presence at surgery of either aortic regurgitation or stenosis was clearly related to age, with regurgitation predominating in patients under 55 years, and aortic stenosis in older patients.Multivariate Cox analysis showed that aortic stenosis (hazard ratio 4.1, p=0.001), indexed ascending aorta dilatation (hazard ratio 3.0, p=0.03) and left ventricular end-diastolic diameter ≥ 60 mm (hazard ratio=4.0, p=0.01) at diagnosis were factors associated with future surgery. Aortic dissection was not observed in patients that did not undergo surgery.
A relatively conservative approach for the indication of ascending aortic surgery in BAV is safe. In this setting, the presence of aortic or left ventricle dilatation and aortic stenosis at diagnosis of BAV were predictive of the need for surgery in the follow-up.
二叶式主动脉瓣（BAV）增加了主动脉瓣功能障碍和升主动脉瘤的风险，因此需要进行主动脉瓣置换和/或主动脉修复。然而，对于手术的标准和手术预测因素，尚无普遍共识。本研究旨在探讨在严格的长期随访和相对保守的手术标准下，手术需求的相关因素。
我们前瞻性随访了 120 例 BAV 患者。评估了未来需要进行主动脉瓣置换和升主动脉修复的相关因素。当升主动脉直径≥55mm 时进行主动脉手术，并根据患者特征和存在严重主动脉瓣功能障碍（主动脉瓣直径≥50mm）推荐手术。
在随访期间（平均 86 个月），34 例患者（28%）（平均年龄 56±12 岁）接受了手术治疗。主动脉瓣功能障碍（n=22；64%）和升主动脉扩张（n=12；36%）是手术的指征。在诊断 BAV 时，最常见的瓣膜功能障碍是主动脉瓣反流，但最常见的手术指征是主动脉瓣狭窄。手术时存在主动脉瓣反流或狭窄与年龄明显相关，反流在 55 岁以下的患者中更为常见，而主动脉瓣狭窄在年龄较大的患者中更为常见。多变量 Cox 分析显示，手术时主动脉瓣狭窄（危险比 4.1，p=0.001）、指数化升主动脉扩张（危险比 3.0，p=0.03）和左心室舒张末期直径≥60mm（危险比=4.0，p=0.01）是与未来手术相关的因素。未行手术的患者未发生主动脉夹层。
在 BAV 中，采用相对保守的升主动脉手术指征是安全的。在这种情况下，诊断 BAV 时存在主动脉或左心室扩张和主动脉瓣狭窄是随访中需要手术的预测因素。
