Increased risk of late aortic events after isolated aortic valve replacement in patients with bicuspid aortic valve insufficiency versus stenosis

Aim. Bicuspid aortic valve (BAV) is a very heterogeneous disorder and risk of aortic events in BAV may be influenced by phenotype of the disease. Correlation has been proposed between aortic dilatation patterns and functional status of the BAV (i.e., stenosis versus insufficiency). The aim of our study was to evaluate the risk of late aortic events after isolated aortic valve replacement (AVR) in patients with BAV stenosis versus insufficiency. Methods. Review of our institutional BAV database identified 442 consecutive BAV patients (mean age 55 +/- 12 years, 76% men), who underwent isolated AVR from 1995 through 2005. A subgroup of 376 (85%) patients presented with an isolated/predominant BAV stenosis (Group I), whereas 66 (15%) patients had an isolated BAV insufficiency (Group II). Follow-up information (a total of 3864 patient-years) was 100% complete. Mean follow-up period was 9.4 +/- 3.9 years. Adverse aortic events were defined as the need for proximal aortic surgery or the occurrence of aortic dissection/rupture, or sudden death during follow-up: Results. Actuarial survival rates in Group I and Group II were 86 +/- 2% vs. 94 +/- 3% at 10 years, and 76 +/- 3% vs. 85 +/- 6% at 15 years, respectively (P=0.2). Proximal aortic surgery was performed in 6 (1.5%) patients in Group I vs. 2 (3%) patients in Group II. Freedom from proximal aortic re-interventions was 95 +/- 3% in Group I vs. 90 +/- 8% in Group II at 15 years after AVR (P=0.4). Aortic dissection/rupture occurred in 2 patients in Group II. Freedom from late adverse aortic events was 93 3% in Group I vs. 78 +/- 9% in Group II at 15 years postoperatively (P=0.02). Conclusion. BAY patients with isolated valve insufficiency are at increased risk of late aortic events, as compared with BAV stenosis patients at 15 years after AVR.