Wulffeld Sandra, Schmiegelow Michelle Dalgas Skøtt, Oksjoki Riina, Nielsen Dorte Guldbrand, Schmiegelow Søren Skøtt, Ngo Anh Thuc, Raunsø Jakob, Larsen Morten Kranker, Bruun Niels Eske, Procida Kristina
Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Clin Res Cardiol. 2025 Aug 19. doi: 10.1007/s00392-025-02725-1.
The anatomy of bicuspid aortic valves (BAV) varies considerably and is broadly classified into two main types: two-sinus and fused BAV. Possible prognostic implications of these two main types remain unclear. This study aimed to assess potential associations between BAV morphology and the timing of surgery of the aortic valve or ascending aorta.
A multi-center cohort study including 1004 adult outpatients with BAV. BAV morphology was classified as either two-sinus or fused type. The primary outcome was a composite of surgical or endovascular intervention on the aortic valve or ascending aorta. The effect of morphology on the primary outcome was investigated using delayed-entry cause-specific Cox regression models using age as timescale.
A total of 835 patients with fused BAV and 169 with two-sinus BAV were followed for 2044 person-years. Two-sinus BAV patients were younger (median age 47.2 vs. 53.6 years, p = 0.0002) with a higher prevalence of aortic coarctation (24% vs. 12%, p = 0.0003). The incidence rate of surgery was 9.3 per 100 person-years in fused BAV patients and 10.7 per 100 person-years in two-sinus BAV patients (difference [95%CI]: 1.42 [- 2.3, 5.1] per 100 person-years). Two-sinus morphology was associated with a higher age-related hazard of surgery compared to fused BAV (HR [95%CI]: 1.46 [1.02, 2.09]), a finding that remained significant after adjusting for sex.
Two-sinus BAV morphology was associated with a significantly higher age-related likelihood of requiring surgery on the aortic valve or ascending aorta.
二叶式主动脉瓣（BAV）的解剖结构差异很大，大致可分为两种主要类型：双窦型和融合型BAV。这两种主要类型可能的预后影响仍不明确。本研究旨在评估BAV形态与主动脉瓣或升主动脉手术时机之间的潜在关联。
一项多中心队列研究，纳入1004例成年BAV门诊患者。BAV形态分为双窦型或融合型。主要结局是主动脉瓣或升主动脉的手术或血管内介入治疗的综合结果。使用以年龄为时间尺度的延迟进入特定病因Cox回归模型，研究形态对主要结局的影响。
共对835例融合型BAV患者和169例双窦型BAV患者进行了2044人年的随访。双窦型BAV患者更年轻（中位年龄47.2岁对53.6岁，p = 0.0002），主动脉缩窄的患病率更高（24%对12%，p = 0.0003）。融合型BAV患者的手术发生率为每100人年9.3例，双窦型BAV患者为每100人年10.7例（差异[95%CI]：每100人年1.42[-2.3,5.1]例）。与融合型BAV相比，双窦型形态与更高的与年龄相关的手术风险相关（HR[95%CI]：1.46[1.02,2.09]），在调整性别后这一发现仍然显著。
双窦型BAV形态与主动脉瓣或升主动脉手术的年龄相关可能性显著更高有关。
