Girdauskas Evaldas, Disha Kushtrim, Borger Michael A, Kuntze Thomas
Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
Interact Cardiovasc Thorac Surg. 2014 Mar;18(3):355-9. doi: 10.1093/icvts/ivt518. Epub 2013 Dec 12.
The risk of acute aortic events in patients with bicuspid aortic valve (BAV) disease is a controversial issue. The real risk of aortic dissection in patients with BAV disease is unknown. An indirect assessment of this risk, however, could be gained with a more detailed understanding of the pathogenesis of BAV aortopathy. There are two major issues that should be clarified before one addresses the question of aortic dissection risk in BAV patients. The first issue, when analysing the data from previous BAV cohorts, is to determine what stage of BAV disease was present in the described patient population. In particular, was the risk of aortic dissection in BAV patients determined before or after aortic valve replacement (AVR) surgery? The second issue to consider is the functional state of the pathological valve within the observed population. In particular, did patients predominantly suffer from BAV stenosis or BAV insufficiency? Unfortunately, the vast majority of published reports do not separate between the different BAV phenotypes, thereby complicating interpretation of the results. Considering these two important clinical variables (i.e. the stage of BAV disease and the functional phenotype), we herein aim to explain the inconsistency of the published data with regard to the risk of aortic dissection in patients with BAV disease.
二叶式主动脉瓣（BAV）疾病患者发生急性主动脉事件的风险是一个存在争议的问题。BAV疾病患者发生主动脉夹层的实际风险尚不清楚。然而，通过更详细地了解BAV主动脉病变的发病机制，可以对这种风险进行间接评估。在探讨BAV患者主动脉夹层风险问题之前，有两个主要问题需要阐明。第一个问题是，在分析以往BAV队列的数据时，要确定所描述的患者群体处于BAV疾病的哪个阶段。特别是，BAV患者发生主动脉夹层的风险是在主动脉瓣置换（AVR）手术之前还是之后确定的？第二个需要考虑的问题是观察人群中病理性瓣膜的功能状态。特别是，患者主要是患有BAV狭窄还是BAV关闭不全？不幸的是，绝大多数已发表的报告并未区分不同的BAV表型，从而使结果的解释变得复杂。考虑到这两个重要的临床变量（即BAV疾病的阶段和功能表型），我们在此旨在解释已发表数据中关于BAV疾病患者主动脉夹层风险的不一致性。
