Efficacy of aortic valve replacement for bicuspid aortic valve: a medium-term follow-up study based on propensity score matching analysis

Abstract

Objective To investigate the differences and factors influencing the medium-term outcomes of aortic valve replacement (AVR) between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients. Methods A total of 245 patients who underwent AVR in our hospital from January 2014 to June 2019 and met our inclusion criteria were retrospectively recruited in this study, and were divided into TAV group (n=158) and BAV group (n=87), including 15 cases of type 0 Ap, 21 cases of type 0 Lat, 45 cases of type 1, and 6 cases of type 2. The 1:1 propensity score matching method (PSM) was used to screen the matching cohort, and the intraoperative, perioperative and follow-up outcomes were compared. Multivariate Logistic regression analysis was performed to evaluate the factors affecting the continued dilation of the ascending aorta. Results After PSM, 69 pairs of matching cohorts were selected and the baseline data of the 2 groups were basically balanced. Intraoperative and perioperative outcomes did not differ between the 2 groups. During the median follow-up time of 45 months, there were no significant differences in the diameter of the ascending aorta, diameter of the aortic sinus and its changes, incidence of adverse aortic events, functional status of the prosthetic valve, and classification of cardiac function between the 2 groups, while the difference of ascending aorta change, annual change rate, and proportion of continuous dilation of ascending aorta were significantly higher in the BAV group than the TAV group (P=0.016, 0.010, 0.041). Multivariate Logistic regression analysis of PSM cohort showed that BAV types (OR=3.296, 95%CI: 1.473~7.372), aortic regurgitation (OR=6.491, 95%CI: 2.691~15.657) and aortic valve stenosis with regurgitation (OR=8.233, 95%CI: 2.565~26.429) were positively correlated with the continued dilatation of the ascending aorta after AVR. Furthermore, after the BAV cohort was screened out from the PSM cohort, multivariate Logistic regression analysis indicated that type 1 in BAV (OR=10.378, 95%CI: 1.587~67.853), smoking (OR=4.959, 95%CI: 1.158~21.231) and aortic regurgitation (OR=8.070, 95%CI: 1.729~37.674) were positively correlated with the continued dilatation of the ascending aorta after AVR in BAV patients. Conclusion BAV patients are more likely to continue to dilate the ascending aorta after AVR when compared with TAV patients, and type 1 in BAV, smoking and aortic regurgitation are independent risk factors in BAV patients.

Keywords

• bicuspid aortic valve
• aortic valve replacement
• risk factors
• propensity score matching