Surgical Aortic Valve Replacement For Bicuspid And Tricuspid Valve Disease: 7-Year Outcomes In >1100 Patients

Authors

  • Louis Labrousse Medico-Surgical Department of Valvulopathies, Bordeaux Heart University Hospital, Bordeaux-Pessac, France
  • Michael G. Moront Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, OH, USA
  • Francois Dagenais Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, QC, Canada
  • Michael J. Reardon Department of Cardiovascular Surgery and Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
  • G. Michael Deeb Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
  • Ralf Günzinger Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Germany
  • Marc Ruel Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
  • Tianhua Wu Clinical Research and Medical Science, Cardiac Surgery, Medtronic, Mounds View, MN
  • Robert J. M. Klautz Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
  • Joseph F. Sabik Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA

DOI:

https://doi.org/10.48729/pjctvs.531

Keywords:

Surgical aortic valve replacement, congenital bicuspid aortic valve, tricuspid aortic valve, aortic valve surgery, aortic stenosis, aortic regurgitation

Abstract

Introduction: Bicuspid aortic valve affects 0.5-2% of the population in developed countries. Given uncertainties about the best aortic valve replacement (AVR) option in this often younger, low-risk, population, it is important to understand how newer bioprostheses perform in these patients. The primary objective of this analysis was to compare 7-year outcomes of surgical AVR (SAVR) with the Avalus bioprosthesis between patients with a congenital bicuspid or tricuspid valve.
Methods: This prospective, non-randomized study included 1132 patients with aortic valve stenosis or chronic severe aortic regurgitation who underwent successful SAVR with the Avalus bioprosthesis. Patients were categorized into bicuspid (n=339) and tricuspid (n=775) groups; 18 patients had unknown etiology. Kaplan-Meier analyses estimated valve-related adverse events over 7 years. Multivariable Cox proportional hazard models with propensity score adjustments evaluated the association of valve etiology with clinical outcomes, and a multivariable analysis identified risk factors for all-cause mortality.
Results: Patients with a tricuspid valve were older with more advanced heart failure symptoms and a higher mean Society of Thoracic Surgeons risk score (P<0.01). At 7 years postimplant, mortality was lower [8.9% (95% CI: 5.9%-13.4%) versus 21.3% (95% CI: 18.1%-24.9%), P<0.01] and non-structural valve dysfunction was higher in the bicuspid cohort [2.9% (95% CI: 1.5%-5.5%) versus 0.6% (95% CI: 0.2%-1.6%), P<0.01]. Other safety parameters were not significantly different. In the bicuspid and tricuspid cohorts, the respective mean effective orifice area was 2.0±0.5 and 2.0±0.5 at 7 years, and the respective mean aortic gradient was 13.6±6.4 and 14.1±5.7. Reintervention rates were low [6.8% (95% CI: 4.1%-10.9%) versus 5.4% (95% CI: 3.7%-7.8%), P=0.54] in both cohorts.
Conclusions: SAVR with the Avalus bioprosthesis yielded excellent 7-year outcomes for patients with either a congenital bicuspid or tricuspid valve. Hemodynamic performance and reintervention rates were similar between cohorts with low rates of other valve-related adverse events.

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Published

29-04-2025

How to Cite

1.
Labrousse L, Moront MG, Dagenais F, Reardon MJ, Deeb GM, Günzinger R, Ruel M, Wu T, Klautz RJM, Sabik JF. Surgical Aortic Valve Replacement For Bicuspid And Tricuspid Valve Disease: 7-Year Outcomes In >1100 Patients. Rev Port Cir Cardiotorac Vasc [Internet]. 2025 Apr. 29 [cited 2025 May 4];32(1):25-33. Available from: https://pjctvs.com/index.php/journal/article/view/531

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Vol. 32 No. 1 (2025): Jan-Mar

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