Demographic Characteristics, BAV Sievers Types, and Interactions Between BAV-Associated Valvulopathy and Aortopathy Differently Affect BAV Comorbidities and Outcomes of Aortic Valve Replacement

BackgroundBicuspid aortic valve (BAV) is a common congenital disorder. The relationship between demographic and clinical characteristics, BAV Sievers types, BAV associated valvulopathy and/or aortopathy and outcomes of aortic valve replacement (AVR) are interwoven and complicate and have not been fully elucidated. We sought to find these interactions in a large cohort of BAV patients. MethodsWe retrospectively reviewed the data of 992 BAV patients and collected the complete demographic and clinical data (baseline characteristic, BAV Sievers types, BAV valvulopathy and aortopathy, and pre-, intra- and postoperative data) to comprehensively analyze these relationships. ResultsIn 992 BAV patients, sex differences could be found in demography (body surface area [BSA], age and serum triglyceride), comorbidities, cardiac performance (left ventricular dimension and ejection fraction,), valvulopathy and aortopathy. Sievers types had the same distribution among male and female patients, and had an impact on the incidence of valvulopathy and aortopathy. In the entire cohort, the factors associated with valvulopathy included age, sex, BSA, systolic blood pressure (SBP) and aortopathy, while factors associated with aortopathy were age, sex, BSA and valvulopathy. Aortopathy and valvulopathy promoted the occurrence of each other. Similar risk factors for valvulopathy and aortopathy in male patients were found. For 658 BAV patients underwent AVR, the preoperative demographic characteristics were similar to the whole cohort. More males were required to have simultaneous ascending aortic replacement (AAR). For postoperative early adverse events (EAE) and total ICU hours > 24 hours, the only predict factors were age and aortic cross clamp (ACC) time, while LVEF changes (including postoperative LVEF <50%, LVEF increase or decrease more or less than 5% or 10%) were related to sex, SBP, preoperative LVEF, valvulopathy and aortopathy, AAR, ACC time. Postoperative length of stay > 7 days could be affected by SBP, AAR, aortic stenosis and ACC time. ConclusionOur study revealed comprehensive relationships between demographic characteristics, BAV Sievers types, valvulopathy and aortopathy, and the possible risk factors for adverse outcomes after AVR in BAV patients. Sex, SBP, age, Sievers types, subtypes and interactions between aortopathy and valvulopathy differently impact on aortopathy, valvulopathy and the short outcomes of AVR.