Aortic regurgitation caused by rupture of a well-balanced fibrous strand suspending a degenerative tricuspid aortic valve

Abstract Background Bicuspid aortic valve (BAV) is an important cause of AR; these patients belong to a young and male predominant population and are distinctively different from tricuspid aortic valve (TAV). However, the differences between BAV and TAV in AR have not been completely explored. Purpose To explore differences between patients with BAV and TAV in hemodynamically significant aortic regurgitation (AR). Methods Consecutive patients with ≥moderate-severe AR were retrospectively identified from 2006 to 2017. Results Of 798 patients (502 with TAV, mean age 67±14 years; 296 with BAV, mean age 46±14 years) followed for 6.1±3.6 years, 403 underwent AV surgery (AVS); 154 died during follow-up. BAV men (94%) tended to become symptomatic when left ventricle enlarged; TAV patients became symptomatic before left ventricular (LV) enlargement. During follow-up, BAV patients had lower mortality (hazard ratio [HR], 0.19; P<0.0001) and higher incidence of AVS (HR, 1.28; P=0.01) than TAV, which attenuated after adjusted on age, sex, comorbidities, LV ejection fraction (LVEF), functional class, and time-dependent AVS. In a propensity-matched cohort, differences of survival and incidence of AVS between BAV and TAV were not demonstrated. After a median of 6.3 (IQR: 3.3–9.3) years, 53 patients died post-AVS; TAV patients having class I surgical triggers had poor survival than TAV-non-class I patients and BAV patients with and without class I triggers (Figure). Class I triggers had no effect on BAV patients regarding post-AVS survival. LVEF<60% was associated with increased mortality in both TAV and BAV. Conclusions The correlation between larger LV size and symptomatic status only applied in BAV men. Patients with BAV and significant AR tended to have better survival and higher incidence of AVS, likely driven by inherent younger age and less comorbidity than patients with TAV. Class I surgical triggers had heavier negative impact on poor survival in TAV patients. The cutoff of LV dysfunction in AR may be LVEF 60%. Figure 1. Kaplan-Meier curves post-AVS Funding Acknowledgement Type of funding source: None

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Faculty Opinions recommendation of Two decades of valve-sparing root reimplantation in tricuspid aortic valve: impact of aortic regurgitation and cusp repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739235169.793581439 ◽

2020 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Tricuspid Aortic Valve ◽

Valve Sparing

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Contemporary differences between bicuspid and tricuspid aortic valve in chronic aortic regurgitation

Heart ◽

10.1136/heartjnl-2020-317466 ◽

2020 ◽

pp. heartjnl-2020-317466

Author(s):

Li-Tan Yang ◽

Giovanni Benfari ◽

Mackram Eleid ◽

Christopher G Scott ◽

Vuyisile T Nkomo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Real Life ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Tertiary Referral Centre ◽

Ventricular Ejection Fraction ◽

Tricuspid Aortic Valve ◽

Risk Of Death ◽

Chronic Aortic Regurgitation

ObjectiveTo comprehensively explore contemporary differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with chronic haemodynamically significant aortic regurgitation (AR).MethodsConsecutive patients with chronic ≥moderate-severe AR from a tertiary referral centre (2006–2017) were included. All-cause mortality, surgical indications and aortic valve surgery (AVS) were analysed.ResultsOf 798 patients (296 BAV-AR, age 46±14 years; 502 TAV-AR, age 67±14 years, p<0.0001) followed for 5.5 (IQR: 2.9–9.2) years, 403 underwent AVS (repair in 96) and 154 died during follow-up. The 8-year AVS incidence was 60%±3% versus 53%±3% for BAV-AR and TAV-AR, respectively (p=0.014). The unadjusted (real-life) 8-year total survival was 93%±7% versus 71%±2% for BAV-AR and TAV-AR, respectively (p<0.0001), and became statistically insignificant after sole adjustment for age (p=0.14). The within-group relative risk of death in BAV-AR patients demonstrated a large age-dependent increase (two fold at 50–55 years, up to 10-fold at 70 years). The presence of baseline symptoms was significantly associated with death for both BAV-AR (p=0.039) and TAV-AR (p<0.0001), but the strength of the association decreased with age adjustment for BAV-AR (age-adjusted HR 2.43 (0.92–6.39), p=0.07) and not for TAV-AR (age-adjusted HR, 2.3 (1.6–3.3), p<0.0001). As compared with general population, TAV-AR exhibited baseline excess risk which further increased at left ventricular ejection fraction (LVEF) <60% and left ventricular end-systolic dimension index (LVESDi) >20 mm/m2; similar thresholds were observed for BAV-AR patients.ConclusionBAV-AR patients were two decades younger than TAV-AR and underwent AVS more frequently, resulting in a considerable real-life survival advantage for BAV-AR that was determined primarily by age and not valve anatomy. Pragmatically, regardless of valve anatomy, patients with haemodynamically significant AR and age >50–55 years require a low-threshold for surgical referral to prevent symptom development where LVEF <60% and LVESDi >20 mm/m2 seem appropriate referral thresholds.

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Collagen analysis in aneurysmal ascending aorta obtained from patients with bicuspid aortic valve disease compared with tricuspid aortic valve aneurysm

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1367284 ◽

2014 ◽

Vol 62 (S 01) ◽

Author(s):

A. Navarrete Santos ◽

P. Lochmann ◽

J.Y. Yan ◽

A. Simm ◽

R.-E. Silber ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valve Disease ◽

Ascending Aorta ◽

Valve Disease ◽

Tricuspid Aortic Valve ◽

Collagen Analysis

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Emergency aortic root replacement with the Bioconduit stentless aortic valve conduit

ROMANIAN BIOTECHNOLOGICAL LETTERS ◽

10.25083/rbl/25.6/2055.2059 ◽

2020 ◽

Vol 25 (6) ◽

pp. 2055-2059

Author(s):

ADRIAN TULIN ◽

◽

OVIDIU STIRU ◽

MIRUNA LUANA MIULESCU ◽

LAURA RADUCU ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Aortic Root ◽

Aortic Root Replacement ◽

Bentall Operation ◽

Severe Aortic Regurgitation ◽

Valve Conduit ◽

Successful Case ◽

Valved Conduit

This report concerns a 73-year-old woman who presented with asymptomatic aortic root an-eurysm with severe aortic regurgitation. The purpose of this article is to present our first successful case for emergency aortic root replacement (Bentall operation) that involves annular implantation of a pericardial valved conduit (Bioconduit TM, Biointegral Surgical, Inc., Ontario, Canada) and to discuss some essential technical clue issues related to this approach.

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