Bicuspid Aortic Valve Durability with Valve-Sparing Aortic Root Replacement: Comparison to Tricuspid Valve

Abstract

Objectives Outcomes beyond 10 years for David V valve-sparing aortic root replacement (VSARR) in bicuspid aortic valve (BAV) patients have yet to be explored. We investigated long-term outcomes after BAV VSARR compared to VSARR for tricuspid aortic valve (TAV) patients.
Methods A total of 677 patients with BAV (n = 171) and TAV (n = 506) underwent VSARR between 2005-2020 from two aortic centers, excluding those with dissection, endocarditis, stenosis, or prior aortic valve surgery. Multivariable Cox regression compared adjusted survival over a 12-year period. Fine and Gray competing risk regression compared risk and cumulative incidence of reoperation/reintervention. Propensity score matching (PSM) created balanced groups, and landmark analysis isolated outcomes beginning four years postoperatively. Finally, longitudinal mixed modeling assessed aortic valve deterioration on echocardiogram.
Results No difference was observed in 12-year survival of BAV vs TAV (PSM 92.0% vs 89.9%, p = 0.97; multivariable HR 0.76, 95% CI 0.34-1.69. p = 0.51). Adjusted 12-year cumulative incidence and risk of aortic valve and/or proximal aorta reoperation/reintervention were not observed to be different (15.7% BAV vs 5.7% TAV, p = 0.37; sHR 1.54, 95% CI 0.60-3.94, p = 0.36); however, landmark analysis showed increased incidence of late reoperation/reintervention in BAV vs TAV (11.7% vs 0.0%, p = 0.04). BAV was not associated with aortic valve deterioration over time (BAV coefficient ± standard error: 0 ± 0.30, p = 1).
Conclusions VSARR for bicuspid aortic valve patients has excellent 12-year survival and low reoperation/reintervention rates, that were not observed to be different from TAV patients. However, higher incidence of reoperation/reintervention was observed in the late years after BAV VSARR. Our study provides key information for surgical consultation of patients with bicuspid aortopathy.

Keywords: aortic disease, aortic root replacement, valve-sparing, bicuspid