TY - JOUR
T1 - Surgical repair of bicuspid aortopathy at small diameters
T2 - Clinical and institutional factors
AU - BAVCon Investigators
AU - GenTAC Registry Investigators
AU - Nissen, Alexander P.
AU - Truong, Van Thi Thanh
AU - Alhafez, Bader A.
AU - Puthumana, Jyothy J.
AU - Estrera, Anthony L.
AU - Body, Simon C.
AU - Prakash, Siddharth K.
AU - Bossone, Eduardo
AU - Citro, Rodolfo
AU - Body, Simon
AU - Muehlschlegel, J. Daniel
AU - Shahram, Jasmine T.
AU - Nguyen, Thy B.
AU - Stefano Nistri, Vicenza
AU - Gilon, Dan
AU - Durst, Ronen
AU - de Vincentiis, Carlo
AU - Pluchinotta, Francesca R.
AU - Sundt, Thoralf M.
AU - Michelena, Hector I.
AU - Limongelli, Giuseppe
AU - McCarthy, Patrick M.
AU - Malaisrie, S. Chris
AU - Bavishi, Aakash
AU - Bissell, Malenka M.
AU - Huggins, Gordon S.
AU - Dayan, Victor
AU - Dagenais, Francois
AU - Corte, Alessandro Della
AU - Girdsaukas, Evaldas
AU - Yang, Bo
AU - Eagle, Kim
AU - Milewicz, Dianna M.
AU - Nguyen, Tom C.
AU - Sandhu, Harleen K.
AU - Safi, Hazim J.
AU - Denny, Josh C.
AU - Evangelista, Arturo
AU - Galian-Gay, Laura
AU - Eagle, Kim A.
AU - Ravekes, Williams
AU - Dietz, Harry C.
AU - Holmes, Kathryn W.
AU - Habashi, Jennifer
AU - LeMaire, Scott A.
AU - Coselli, Joseph S.
AU - Morris, Shaine A.
AU - Maslen, Cheryl L.
AU - Song, Howard K.
AU - Silberbach, G. Michael
N1 - Publisher Copyright:
© 2019 The American Association for Thoracic Surgery
PY - 2020/6
Y1 - 2020/6
N2 - Objective: Bicuspid aortic valve is a common risk factor for thoracic aortic aneurysm and dissection. Guidelines for elective ascending aortic intervention (AAI) in bicuspid aortic valve are derived from limited evidence, and the extent of practice variation due to patient and provider characteristics is unknown. Using data from 2 large cardiovascular registries, we investigated factors that influence decisions for AAI. Methods: All bicuspid aortic valve cases with known aortic diameters and surgical status were included. We used multivariable logistic regression to profile predictors of isolated aortic valve replacement (AVR) or AVR+AAI, stratified by patient characteristics, surgical indications, and institution. Results: We studied 2861 subjects at 18 institutions from 1996 to 2015. The median aortic diameter of patients who underwent AVR+AAI varied widely across institutions (39-52 mm). Aortic diameters were <45 mm in 38% of patients undergoing AVR+AAI. Patients who underwent AAI at <45 mm, compared with those managed nonoperatively, were younger (54 ± 13 vs 61 ± 15 years; P < .001) with more frequent aortic stenosis (53% vs 28%; P < .001) and regurgitation (52% vs 18%; P < .001). Conclusions: Clinical and institutional factors influence the timing of AAI and are associated with significant variability in ascending aortic diameter at AAI across institutions. More than one third of patients with a bicuspid aortic valve undergo AAI at aortic diameters <45 mm. Long-term outcomes of this subgroup of patients, who may manifest earlier and more severe disease, are needed to determine the risk–benefit ratio of routine aortic interventions at smaller diameters.
AB - Objective: Bicuspid aortic valve is a common risk factor for thoracic aortic aneurysm and dissection. Guidelines for elective ascending aortic intervention (AAI) in bicuspid aortic valve are derived from limited evidence, and the extent of practice variation due to patient and provider characteristics is unknown. Using data from 2 large cardiovascular registries, we investigated factors that influence decisions for AAI. Methods: All bicuspid aortic valve cases with known aortic diameters and surgical status were included. We used multivariable logistic regression to profile predictors of isolated aortic valve replacement (AVR) or AVR+AAI, stratified by patient characteristics, surgical indications, and institution. Results: We studied 2861 subjects at 18 institutions from 1996 to 2015. The median aortic diameter of patients who underwent AVR+AAI varied widely across institutions (39-52 mm). Aortic diameters were <45 mm in 38% of patients undergoing AVR+AAI. Patients who underwent AAI at <45 mm, compared with those managed nonoperatively, were younger (54 ± 13 vs 61 ± 15 years; P < .001) with more frequent aortic stenosis (53% vs 28%; P < .001) and regurgitation (52% vs 18%; P < .001). Conclusions: Clinical and institutional factors influence the timing of AAI and are associated with significant variability in ascending aortic diameter at AAI across institutions. More than one third of patients with a bicuspid aortic valve undergo AAI at aortic diameters <45 mm. Long-term outcomes of this subgroup of patients, who may manifest earlier and more severe disease, are needed to determine the risk–benefit ratio of routine aortic interventions at smaller diameters.
KW - ascending aortic intervention
KW - bicuspid aortic valve
KW - thoracic aortic aneurysm
KW - thoracic aortic dissection
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U2 - 10.1016/j.jtcvs.2019.06.103
DO - 10.1016/j.jtcvs.2019.06.103
M3 - Article
C2 - 31543305
AN - SCOPUS:85072302728
SN - 0022-5223
VL - 159
SP - 2216-2226.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -