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, et al. 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 Nov. 15];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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