• J. Thorac. Cardiovasc. Surg. · Feb 2025

    Multicenter Study

    Long-term outcomes after aortic root replacement for bicuspid aortic valve-associated aneurysm.

    • Kavya Rajesh, Megan Chung, Dov Levine, Elizabeth Norton, Parth Patel, Patra Childress, Yanling Zhao, Pengchen Wang, Bradley Leshnower, Paul Kurlansky, Edward Chen, and Hiroo Takayama.
    • Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY.
    • J. Thorac. Cardiovasc. Surg. 2025 Feb 1; 169 (2): 609616.e4609-616.e4.

    ObjectivePatients with congenital bicuspid aortic valve often require root replacement. This study aims to describe their long-term rates of mortality and reoperation.MethodsThis is a multicenter retrospective study of 747 patients with bicuspid aortic valve who underwent aortic root replacement for aortic aneurysm between 2004 and 2020. Cumulative incidence curves for aortic valve and aortic reoperations were graphed. A Kaplan-Meier survival curve for the patient cohort was created alongside an age- and sex-matched curve for the US population. Multivariable Cox regression was used to determine characteristics associated with long-term mortality.ResultsThe median age of our cohort was 54 [43-64] years old, and 101 (13.5%) patients were female. In patients with bicuspid aortic valve dysfunction, 274 (36.7%) had aortic insufficiency, 187 (25.0%) had aortic stenosis, and 142 (19.0%) had both. In-hospital mortality occurred in 10 (1.3%) patients. There were 56 aortic valve reoperations and 19 aortic reoperations, with a combined cumulative incidence of 35% (95% confidence interval [CI], 23%-46%) at 15 years. In addition, there was comparable survival between the patient cohort and the age- and sex-matched US population. Age (hazard ratio [HR], 1.04; 95% CI, 1.01-1.06), concomitant CABG (HR, 2.28; 95% CI, 1.29-4.04), and bypass time (HR, 1.01; 95% CI, 1.00-1.01) were associated with increased mortality.ConclusionsPatients who undergo aortic root replacement with bicuspid aortic valve have an increased rate of aortic reoperation (35%; 95% CI, 23%-46%) while their survival appears to be comparable to the general US population (79%; 95% CI, 73%-87%) at 15 years.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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