Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1191-1199. doi: 10.1093/ejcts/ezaa474.
Patients with bicuspid aortic valve (BAV) comprise a substantial portion of patients undergoing surgical aortic valve replacement (SAVR). Our goal was to quantify the prevalence of BAV in the current SAVR ± coronary artery bypass grafting (CABG) population, assess differences in cardiovascular risk profiles and assess differences in long-term survival in patients with BAV compared to patients with tricuspid aortic valve (TAV).
Patients who underwent SAVR with or without concomitant CABG and who had a surgical report denoting the relevant valvular anatomy were eligible and included. Prevalence, predictors and outcomes for patients with BAV were analysed and compared to those patients with TAV. Matched patients with BAV and TAV were compared using a propensity score matching strategy and an age matching strategy.
A total of 3723 patients, 3145 of whom (mean age 66.6 ± 11.4 years; 37.4% women) had an operative report describing their aortic valvular morphology, underwent SAVR ± CABG between 1987 and 2016. The overall prevalence of patients with BAV was 19.3% (607). Patients with BAV were younger than patients with TAV (60.6 ± 12.1 vs 68.0 ± 10.7, respectively). In the age-matched cohort, patients with BAV were less likely to have comorbidities, among others diabetes (P = 0.001), hypertension (P < 0.001) and hypercholesterolaemia (P = 0.003), compared to patients with TAV. Twenty-year survival following the index procedure was higher in patients with BAV (14.8%) compared to those with TAV (12.9%) in the age-matched cohort (P = 0.015).
Substantial differences in the cardiovascular risk profile exist in patients with BAV and TAV. Long-term survival after SAVR in patients with BAV is satisfactory.
二叶式主动脉瓣（BAV）患者在接受主动脉瓣置换术（SAVR）的患者中占很大比例。我们的目标是量化当前 SAVR ± 冠状动脉旁路移植术（CABG）人群中 BAV 的患病率，评估心血管风险特征的差异，并评估与三叶式主动脉瓣（TAV）患者相比，BAV 患者的长期生存率差异。
符合条件的患者为接受 SAVR ± CABG 手术且手术报告中注明相关瓣膜解剖结构的患者。分析 BAV 患者的患病率、预测因素和结局，并与 TAV 患者进行比较。使用倾向评分匹配策略和年龄匹配策略比较 BAV 和 TAV 匹配患者。
共纳入 3723 例患者，其中 3145 例（平均年龄 66.6 ± 11.4 岁，37.4%为女性）的手术报告描述了其主动脉瓣形态学，于 1987 年至 2016 年间接受 SAVR ± CABG 手术。BAV 患者的总体患病率为 19.3%（607 例）。BAV 患者比 TAV 患者年轻（分别为 60.6 ± 12.1 岁和 68.0 ± 10.7 岁）。在年龄匹配队列中，与 TAV 患者相比，BAV 患者更不可能患有合并症，例如糖尿病（P = 0.001）、高血压（P < 0.001）和高胆固醇血症（P = 0.003）。在年龄匹配队列中，与 TAV 患者相比，索引手术后 20 年生存率在 BAV 患者中更高（14.8%比 12.9%，P = 0.015）。
BAV 和 TAV 患者的心血管风险特征存在显著差异。BAV 患者接受 SAVR 后的长期生存率令人满意。
