Lim Michelle S, Celermajer David S, Bannon Paul G
The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
Royal Prince Alfred Hospital, Department of Cardiology, Camperdown, New South Wales, Australia.
Int J Cardiol Heart Vasc. 2021 Apr 26;34:100786. doi: 10.1016/j.ijcha.2021.100786. eCollection 2021 Jun.
Patients with bicuspid aortic valve (BAV) with zero or two raphes have been under-represented in previous studies. Whether these patients have unique clinical courses remains unclear. We describe the indications for and types of surgery in patients with BAV, and describe differences between valve morphotypes.
Adults who had undergone aortic and/or aortic valve surgery for BAV disease at our centres were identified and classified according to the Sievers definitions.
317 patients were included (74.4% male, median age at surgery 62 years). Of these, 187 (59.0%) had aortic valve surgery, 7 (2.2%) aortic surgery, 120 (37.9%) combined valve and aortic surgery and 3 had a Ross procedure. Most patients had aortic stenosis (71.9%), followed by aortic regurgitation (16.7%). 30-day mortality was low (1.6%).The commonest valve morphology was type-1 (one raphe) in 89.6%; type-0 (no raphes) occurred in 7.9% and type-2 (two raphes) in 2.5%. Patients with type-2 valves were substantially younger at time of surgery than type-1 patients (median 36 vs 63 years, p = 0.008). A higher proportion of patients with type-0 valves required aortic surgery than those with type-1 (68.0% vs 37.3%, p = 0.007). There were no differences between groups for the indication for surgery, valvular abnormality or 30-day mortality.
The number of BAV raphes was independently and significantly associated with age at surgery and the need for aortic intervention. Patients with type 0 and type 2 valves are a small but important proportion of the BAV population, potentially requiring different clinical surveillance and management.
在既往研究中，具有零条或两条嵴的二叶式主动脉瓣（BAV）患者的代表性不足。这些患者是否有独特的临床病程仍不清楚。我们描述了BAV患者的手术指征和手术类型，并描述了瓣膜形态类型之间的差异。
确定在我们中心因BAV疾病接受主动脉和/或主动脉瓣手术的成年人，并根据西弗斯定义进行分类。
纳入317例患者（74.4%为男性，手术时的中位年龄为62岁）。其中，187例（59.0%）接受了主动脉瓣手术，7例（2.2%）接受了主动脉手术，120例（37.9%）接受了瓣膜和主动脉联合手术，3例接受了罗斯手术。大多数患者有主动脉狭窄（71.9%），其次是主动脉反流（16.7%）。30天死亡率较低（1.6%）。最常见的瓣膜形态是1型（一条嵴），占89.6%；0型（无嵴）占7.9%，2型（两条嵴）占2.5%。2型瓣膜患者手术时的年龄明显低于1型患者（中位年龄分别为36岁和63岁，p = 0.008）。0型瓣膜患者需要进行主动脉手术的比例高于1型患者（68.0%对37.3%，p = 0.007）。手术指征、瓣膜异常或30天死亡率在各组之间没有差异。
BAV嵴的数量与手术年龄和主动脉干预需求独立且显著相关。0型和2型瓣膜患者在BAV人群中占比虽小但很重要，可能需要不同的临床监测和管理。
