Korean Circ J.  2018 Jan;48(1):48-58. 10.4070/kcj.2017.0124.

Clinical Characteristics of Korean Patients with Bicuspid Aortic Valve Who Underwent Aortic Valve Surgery

• Sun BJ
• Jin X
• Song JK
• Lee S
• Lee JH
• Park JB
• Lee SP
• Kim DH
• Park SJ
• Kim YJ
• Cho GY
• Song JM
• Kang DH
• Sohn DW

• KMID: 2405045
• DOI: http://doi.org/10.4070/kcj.2017.0124

Abstract

BACKGROUND AND OBJECTIVES
Clinical data for Korean patients with bicuspid aortic valve (BAV) that underwent aortic valve (AV) surgery are currently limited.
METHODS
Data for 1,160 consecutive adult BAV patients who underwent AV surgery from 2000 to 2014 in 4 tertiary referral centers were retrospectively analyzed. A standard case report form was used for clinical and echocardiographic parameters.
RESULTS
Mean age at the time of AV surgery was 59±13 years. The most common cause of AV surgery was aortic stenosis (AS, 892 [77%]), followed by aortic regurgitation (AR, 199 [17%]), and infective endocarditis (69 [6%]). AS showed a skewed peak in the aged population and was the predominant cause of AV surgery (87%) in patients ≥50 years of age, whereas AR (46%) and active infective endocarditis (19%) were more common in younger patients (p < 0.001). Echocardiographic determination of the BAV phenotype revealed that fusion of the right coronary cusp (RCC) and left coronary cusp (LCC) was most common (622 [53%]), followed by fusion of RCC and non-coronary cusp (NCC) (313 [27%]), and fusion of LCC and NCC (42 [4%]); the BAV phenotype could not be determined in the remaining 183 patients (16%). Fusion of RCC and LCC was more commonly observed in patients with AR than in those with AS (74% vs. 49%; p < 0.001).
CONCLUSION
BAV patients were characterized by distinct surgical indications according to their age. Possible associations between BAV phenotypes and surgical indications with potential impacts of ethnicity need to be tested in further studies.

Keyword

Bicuspid aortic valve; Heart valve diseases; Phenotype; Cardiac surgical procedures

MeSH Terms

Adult
Aortic Valve Insufficiency
Aortic Valve Stenosis
Aortic Valve*
Bicuspid*
Cardiac Surgical Procedures
Echocardiography
Endocarditis
Heart Valve Diseases
Humans
Phenotype
Retrospective Studies
Tertiary Care Centers

Figure

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  Figure 1 Study outline for subject enrollment and analysis. AR = aortic regurgitation; AS = aortic stenosis; AV = aortic valve; BAV = bicuspid aortic valve.

• 

  Figure 2 Morphological criteria for BAV phenotype classification. BAV = bicuspid aortic valve; LCC = left coronary cusp; NCC = non-coronary cusp; RCC = right coronary cusp.

• 

  Figure 3 Dominant valvular lesion for AV surgery according to the age groups by decades (A) and cut-off value of 50 years (B). AR = aortic regurgitation; AS = aortic stenosis; AV = aortic valve. *Comparison between groups by age cut-off of 50 years.

• 

  Figure 4 BAV phenotypes in overall and individual centers. BAV morphological phenotypes were classified into 4 type: type 1, RCC-LCC fusion; type 2, RCC-NCC fusion; type 3, LCC-NCC fusion; and type 4, indistinguishable between type 2 and 3. BAV = bicuspid aortic valve; LCC = left coronary cusp; NCC = non-coronary cusp; RCC = right coronary cusp.

• 

  Figure 5 BAV phenotypes described in previous research. BAV = bicuspid aortic valve; Lat = lateral; LN = fusion between left and non-coronary cusps; RL = fusion between right and left coronary cusps; RN = fusion between right and non-coronary cusps. *Orange and blue bars present data from western and Asian countries, respectively; †Lat, BAV presenting with 2 even cusps, no raphe and right-left orientation.

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