175 - Surgical Outcomes and Decision Making for Bicuspid Aortic Valve

Publication Number: 175.6979

Adam M. Larsen, University of Nebraska Medical Center, Omaha, NE, United States; David Danford, University of Nebraska College of Medicine, Omaha, NE, United States; Anji Yetman, Childrens Nebraska/university of nebraska medical center, Omaha, NE, United States

Background: Bicuspid aortic valve (AoV) can be complicated by aortic stenosis/regurgitation, endocarditis, stroke, or heart failure, even after definitive surgical intervention (DSI) like pulmonary autograft (Ross), AoV replacement (mechanical or bioprosthetic), or AoV repair. We hypothesized that survival free from re-intervention or adverse event varies depending on choice of initial DSI.

Objective: In this retrospective cohort analysis, we aim to better inform surgical decision-making by investigating re-intervention, adverse event, and death rates depending on the chosen definitive surgical interventions.

Design/Methods: A single-center cohort study review was conducted on 152 adults who underwent 194 DSI’s during observation, and had their first intervention for bicuspid AoV during childhood. Cohorts were defined by first DSI. Non-definitive interventions, and demographic data including age, sex, comorbid congenital heart disease, and genetic syndrome were recorded. Measured outcomes included time to next AoV procedure, death, transplant, endocarditis, or stroke. Pairwise comparisons by cohort were made for demographic differences and for outcomes of interest. Time-to-outcome was compared among cohorts using Kaplan-Meier method.

Results: Cohorts included 27 patients (pts) who underwent only “non-definitive” procedures and 125 whose first DSI was Ross (61), mechanical AoV replacement (28), bioprosthetic AoV replacement (19), or surgical AoV repair (17), followed for mean 15.9 + 9.6 years. The population was 62% male. Mean first DSI age (14.1±7.6 years) did not vary by cohort. The Ross cohort contained a greater female proportion (46%) than the other cohorts. Ross and mechanical AoV replacement had comparable freedom from death, transplant, or new DSI. Comorbid mitral disease or coarctation were not predictive of survival or time to next DSI. Pts with prior balloon aortic valvuloplasty were more likely to have a mechanical AoV replacement as first DSI, but subsequent outcomes did not differ. Surgical AoV repair and bioprosthetic AoV cohorts required more additional DSI than other cohorts.

Conclusion(s): Ross and mechanical AoV replacement have similar freedom from death, transplant, or next DSI, superior to the outcomes of bioprosthetic AoV and AoV repair. Females were more likely to undergo Ross procedure as the first DSI than mechanical AoV – perhaps due to systemic anticoagulation considerations.

Freedom from re-intervention or death by first definitive procedure
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