Surgical repair of bicuspid aortopathy at small diameters: Clinical and institutional factors

BAVCon Investigators, GenTAC Registry Investigators

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Bicuspid
Aortic Valve
Thoracic Aortic Aneurysm
Aortic Valve Stenosis
Registries
Dissection
Logistic Models
Guidelines
Bicuspid Aortic Valve

Keywords

  • ascending aortic intervention
  • bicuspid aortic valve
  • thoracic aortic aneurysm
  • thoracic aortic dissection

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{82a42c4ea65341358119d5336bb4a8de,
title = "Surgical repair of bicuspid aortopathy at small diameters: Clinical and institutional factors",
abstract = "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.",
keywords = "ascending aortic intervention, bicuspid aortic valve, thoracic aortic aneurysm, thoracic aortic dissection",
author = "{BAVCon Investigators} and {GenTAC Registry Investigators} and Nissen, {Alexander P.} and {Thanh Truong}, {Van Thi} and Alhafez, {Bader A.} and Puthumana, {Jyothy J.} and Estrera, {Anthony L.} and Body, {Simon C.} and Prakash, {Siddharth K.} and Eduardo Bossone and Rodolfo Citro and Muehlschlegel, {J. Daniel} and Shahram, {Jasmine T.} and Nguyen, {Thy B.} and Vicenza Stefano and Gilon, {Nistri Dan} and Ronen Durst and {de Vincentiis}, Carlo and Pluchinotta, {Francesca R.} and Sundt, {Thoralf M.} and Michelena, {Hector I.} and Giuseppe Limongelli and McCarthy, {Patrick M.} and Malaisrie, {S. Chris} and Aakash Bavishi and Bissell, {Malenka M.} and Huggins, {Gordon S.} and Francois Dagenais and Corte, {Alessandro Della} and Evaldas Girdsaukas and Bo Yang and Kim Eagle and Milewicz, {Dianna M.} and Nguyen, {Tom C.} and Sandhu, {Harleen K.} and Safi, {Hazim J.} and Denny, {Josh C.} and Arturo Evangelista and Laura Galian-Gay and Eagle, {Kim A.} and Williams Ravekes and Dietz, {Harry C.} and Holmes, {Kathryn W.} and Jennifer Habashi and LeMaire, {Scott A.} and Coselli, {Joseph S.} and Morris, {Shaine A.} and Maslen, {Cheryl L.} and Song, {Howard K.} and Silberbach, {G. Michael} and Pyeritz, {Reed E.} and Bavaria, {Joseph E.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.06.103",
language = "English (US)",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

Surgical repair of bicuspid aortopathy at small diameters : Clinical and institutional factors. / BAVCon Investigators; GenTAC Registry Investigators.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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 - Thanh Truong, Van Thi

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 - Muehlschlegel, J. Daniel

AU - Shahram, Jasmine T.

AU - Nguyen, Thy B.

AU - Stefano, Vicenza

AU - Gilon, Nistri 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 - 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

AU - Pyeritz, Reed E.

AU - Bavaria, Joseph E.

PY - 2019/1/1

Y1 - 2019/1/1

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

UR - http://www.scopus.com/inward/record.url?scp=85072302728&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072302728&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.06.103

DO - 10.1016/j.jtcvs.2019.06.103

M3 - Article

C2 - 31543305

AN - SCOPUS:85072302728

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -