Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, 90146 Palermo, Italy.
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, 90146 Palermo, Italy; Fondazione Ri.MED, Palermo, Italy.
J Mol Cell Cardiol. 2019 Oct;135:31-39. doi: 10.1016/j.yjmcc.2019.07.010. Epub 2019 Jul 23.
Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV).
Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement.
BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ± 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001).
Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.
二叶式主动脉瓣患者胸主动脉生长和早期心脏手术的预测因素尚未明确。我们的目的是确定二叶式主动脉瓣（BAV）患者升主动脉扩张和心脏手术的预测因素。
将 41 例 BAV 患者与 165 例三尖瓣主动脉瓣（TAV）患者进行比较。所有患者均具有左心室射血分数（EF）>50%、左心室正常大小以及相似程度的主动脉根部或升主动脉扩张。排除了有中重度主动脉瓣狭窄或反流的患者。76%的人群接受了 CT 扫描，中位时间为 4 年（范围：2 至 8 年）重复进行超声心动图检查。使用混合效应纵向线性模型分析 BAV 和 TAV 组的主动脉扩张模式。在生存分析中，主要终点是主动脉置换的择期或急诊手术。
BAV 患者年龄较小，而 TAV 组患者的左心室壁厚度、高血压和血脂异常较 BAV 患者更为明显。生长速度为 0.46±0.04mm/年，BAV 和 TAV 组之间相似（p=0.70）。心脏手术的预测因素是基线时的主动脉尺寸（HR 1.23，p=0.01）、随访期间发生严重主动脉瓣反流（HR 3.49，p=0.04）、主动脉瘤家族史（HR 4.16，p=0.04）和 ST 段抬高型心肌梗死（STEMI）史（HR 3.64，p<0.001）。
与 BAV 主动脉病变相比，TAV 主动脉病变更常见经典的基线危险因素。然而，令人欣慰的是，尽管 BAV 患者平均早 10 年被诊断为动脉瘤且无高血压，但他们的生长速度相对较低，与三尖瓣患者相似。无论主动脉瓣形态如何，有主动脉瘤家族史、冠心病史以及在随访中发生严重主动脉瓣反流的患者，最有可能被转介进行手术。
