Author + information
- Geoffrey Huntley,
- Jeremy Thaden,
- Said Alsidawi,
- Hector Michelena,
- Joseph Maleszewski,
- William Edwards,
- Sorin Pislaru,
- Patricia Pellikka,
- Naser Ammash,
- Kevin Greason,
- Youssef Maalouf,
- Maurice Enriquez-Sarano and
- Vuyisile Nkomo
Background: Structural abnormalities predispose congenitally bicuspid aortic valves (BAV) to early stenosis, but tricuspid aortic valve (TAV) stenosis is associated with cardiovascular risk factors. We hypothesize that TAV aortic stenosis (AS) is associated with more cardiovascular risk factors and worse outcomes after aortic valve replacement (AVR) compared with BAV AS in an age-matched cohort.
Methods: From 888 consecutive patients undergoing AVR for severe AS between January 1, 2010 and December 31, 2012, an age-matched cohort of 198 TAV AS patients and 198 BAV AS patients was identified. All valves were categorized by cardiovascular pathologists.
Results: Table 1 shows characteristics prior to AVR. Five-year survival following AVR was lower in TAV compared to BAV (61 vs 79%, p=0.02). Univariate predictors of mortality after AVR were TAV (p=0.02), dialysis (p=0.02), ejection fraction (EF)<50% (p<0.0001), and Charlson comorbidity index (CCI) (p=0.01). In multivariate analyses, only the CCI and EF<50% remained significant. Survival following AVR for BAV AS was not different than expected (p=0.17), but was worse than expected for TAV AS (p<0.001).
Conclusions: TAV is associated with increased prevalence of cardiovascular risk factors compared to BAV at the time of AVR for severe AS. This suggests AS develops due to an adverse milieu in TAV whereas in BAV it is likely due to flow shear stress. Survival normalizes after AVR in BAV but excess mortality in TAV is related to comorbidities and impaired EF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Valvular Heart Disease: Aortic Stenosis
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1233-026
- 2017 American College of Cardiology Foundation