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Bicuspid aortic valve outcomes

Published online by Cambridge University Press:  12 December 2016

Inês Rodrigues ,
Ana F. Agapito ,
Lídia de Sousa ,
José A. Oliveira ,
Luísa M. Branco ,
Ana Galrinho ,
João Abreu ,
Ana T. Timóteo ,
Sílvia A. Rosa  and
Rui C. Ferreira
Inês Rodrigues*
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Ana F. Agapito
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Lídia de Sousa
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
José A. Oliveira
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Luísa M. Branco
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Ana Galrinho
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
João Abreu
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Ana T. Timóteo
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Sílvia A. Rosa
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
Rui C. Ferreira
Affiliation:
Department of Cardiology, Centro Hospitalar de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal
*
Correspondence to: I. Rodrigues, MD, Department of Cardiology, Hospital de Santa Marta, Rua de Santa Marta, no. 50, 1169-024 Lisbon, Portugal. Tel: +351 21 359 4000/+351 91 723 6667; E-mail: inesgoncalvesrodrigues@gmail.com
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Abstract

Background

Bicuspid aortic valve is the most common CHD. Its association with early valvular dysfunction, endocarditis, thoracic aorta dilatation, and aortic dissection is well established.

Objective

The aim of this study was to assess the incidence and predictors of cardiac events in adults with bicuspid aortic valve.

Methods

We carried out a retrospective analysis of cardiac outcomes in ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre. Outcomes were defined as follows: interventional – intervention on the aortic valve or thoracic aorta; medical – death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission; and a composite end point of both. Kaplan–Meier curves were generated to determine event rates, and predictors of cardiac events were determined by multivariate analysis.

Results

A total of 227 patients were followed-up over 13±9 years; 29% of patients developed severe aortic valve dysfunction and 12.3% reached ascending thoracic aorta dimensions above 45 mm. At least one cardiac outcome occurred in 38.8% of patients, with an incidence rate at 20 years of follow-up of 47±4%; 33% of patients were submitted to an aortic valve or thoracic aorta intervention. Survival 20 years after diagnosis was 94±2%. Independent predictors of the composite end point were baseline moderate–severe aortic valve dysfunction (hazard ratio, 3.19; 95% confidence interval, 1.35–7.54; p<0.01) and aortic valve leaflets calcification (hazard ratio, 4.72; 95% confidence interval, 1.91–11.64; p<0.005).

Conclusions

In this study of bicuspid aortic valve, the long-term survival was excellent but with occurrence of frequent cardiovascular events. Baseline aortic valve calcification and dysfunction were the only independent predictors of events.

Keywords

Aortaaortic valve, bicuspidheart defects, congenitalsurvival
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 518 - 529
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Copyright
© Cambridge University Press 2016 

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