Crawford Erin E, McCarthy Patrick M, Malaisrie S Chris, Puthumana Jyothy J, Robinson Joshua D, Markl Michael, Liu Menghan, Andrei Adin-Cristian, Guzzardi David G, Kruse Jane, Fedak Paul W M
Division of Cardiac Surgery, Northwestern Medicine, Chicago, IL 60611, USA.
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
J Clin Med. 2020 May 5;9(5):1354. doi: 10.3390/jcm9051354.
Bicuspid aortic valve (BAV) is a common congenital heart diagnosis and is associated with aortopathy. Current guidelines for aortic resection have been validated but are based on aortic diameter, which is insufficient to predict acute aortic events. Clinical and translational collaboration is necessary to identify biomarkers that can individualize the timing of prophylactic surgery for BAV aortopathy. We describe our multidisciplinary BAV program, including research protocols aimed at biomarker discovery and results from our longitudinal clinical registry. From 2012-2018, 887 patients enrolled in our clinical BAV registry with the option to undergo four dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) and donate serum plasma or tissue samples. Of 887 patients, 388 (44%) had an elective BAV-related procedure after initial presentation, while 499 (56%) continued with medical management. Of medical patients, 44 (9%) had elective surgery after 2.3 ± 1.4 years. Surgery patients' biobank donations include 198 (46%) aorta, 374 (86%) aortic valve, and 314 (73%) plasma samples. The 4D flow CMR was completed for 215 (50%) surgery patients and 243 (49%) medical patients. Patients with BAV aortopathy can be safely followed by a multidisciplinary team to detect indications for surgery. Paired tissue and hemodynamic analysis holds opportunity for biomarker development in BAV aortopathy.
二叶式主动脉瓣（BAV）是一种常见的先天性心脏病诊断，且与主动脉病变相关。目前关于主动脉切除术的指南已得到验证，但基于主动脉直径，这不足以预测急性主动脉事件。临床和转化研究合作对于识别能够个体化BAV主动脉病变预防性手术时机的生物标志物至关重要。我们描述了我们的多学科BAV项目，包括旨在发现生物标志物的研究方案以及我们纵向临床登记的结果。2012年至2018年期间，887名患者加入了我们的临床BAV登记，他们可以选择接受四维血流心血管磁共振成像（4D流CMR）并捐赠血清血浆或组织样本。在887名患者中，388名（44%）在初次就诊后接受了择期BAV相关手术，而499名（56%）继续接受药物治疗。在接受药物治疗的患者中，44名（9%）在2.3±1.4年后接受了择期手术。手术患者的生物样本库捐赠包括198份（46%）主动脉、374份（86%）主动脉瓣和314份（73%）血浆样本。215名（50%）手术患者和243名（49%）药物治疗患者完成了4D流CMR检查。BAV主动脉病变患者可由多学科团队安全随访以检测手术指征。配对组织和血流动力学分析为BAV主动脉病变的生物标志物开发提供了机会。
