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Progression of Aortic Stenosis in Patients with Bicuspid Aortic Valve
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  • Michael Shang,
  • Arianna Kahler-Quesada,
  • Makoto Mori,
  • Sameh Yousef,
  • Arnar Geirsson,
  • Prashanth Vallabhajosyula
Michael Shang
Yale School of Medicine
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Arianna Kahler-Quesada
Yale School of Medicine
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Makoto Mori
Yale University School of Medicine
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Sameh Yousef
Yale School of Medicine
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Arnar Geirsson
Yale University School of Medicine
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Prashanth Vallabhajosyula
Yale School of Medicine
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Abstract

Background: Bicuspid aortic valve is the most common congenital heart defect and predisposes patients to developing aortic stenosis more frequently and at a younger age than the general population. However, the influence of bicuspid aortic valve on the rate of progression of aortic stenosis remains unclear. Methods: In 236 patients (177 tricuspid aortic valve, 59 bicuspid aortic valve) matched by initial severity of mild or moderate aortic stenosis, we retrospectively analyzed baseline echocardiogram at diagnosis with latest available follow-up echocardiogram. Baseline comorbidities, annualized progression rate of hemodynamic parameters, and hazard of aortic valve replacement were compared between valve phenotypes. Results: Median echocardiographic follow-up was 2.6 (IQR 1.6-4.2) years. Patients with tricuspid aortic stenosis were significantly older with more frequent comorbid hypertension and congestive heart failure. Median annualized progression rate of mean gradient was 2.3 (IQR 0.6-5.0) mmHg/year vs. 1.5 (IQR 0.5-4.1) mmHg/year (p=0.5), and that of peak velocity was 0.14 (IQR 0-0.31) m/s/year vs. 0.10 (IQR 0.04-0.26) m/s/year (p=0.7) for tricuspid vs. bicuspid aortic valve, respectively. On multivariate analyses, bicuspid aortic valve was not significantly associated with more rapid progression of aortic stenosis. In a stepwise Cox proportional hazards model adjusted for baseline mean gradient, bicuspid aortic valve was associated with increased hazard of aortic valve replacement (HR: 1.7, 95% CI [1.0, 3.0], p=0.049). Conclusion: Bicuspid aortic valve may not significantly predispose patients to more rapid progression of mild or moderate aortic stenosis. Guidelines for echocardiographic surveillance of aortic stenosis need not be influenced by valve phenotype.

Peer review status:ACCEPTED

27 Jul 2021Submitted to Journal of Cardiac Surgery
28 Jul 2021Submission Checks Completed
28 Jul 2021Assigned to Editor
05 Aug 2021Reviewer(s) Assigned
14 Aug 2021Review(s) Completed, Editorial Evaluation Pending
15 Aug 2021Editorial Decision: Revise Minor
22 Aug 20211st Revision Received
23 Aug 2021Submission Checks Completed
23 Aug 2021Assigned to Editor
30 Aug 2021Review(s) Completed, Editorial Evaluation Pending
31 Aug 2021Editorial Decision: Accept