Bicuspid Surgical Aortic Valve Replacement: Anatomical Insight, Medium Term 5 Years Outcomes, and Predictors of Mortality: An Echocardiographic Study

IF 0.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-10-25 DOI:10.1155/jocs/6619189

Roslan Aslannif, Si Ling Soh, Yee Sin Tey, Am Haris Norhaliza, Teo Jassie, Lynne Murray Rowina, Kee Soon Chong, Kian Boon Wong, Dillon Jeswant, Mohamed Yunus Alwi, Mohd Ghazi Azmee

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Abstract

Background/Purpose

Bicuspid aortic valves (BAV) are a common cause of surgical aortic valve replacement (SAVR). This study aims to evaluate medium-term (5-year) outcomes, echocardiographic changes, and predictors of mortality in bicuspid SAVR patients, with a focus on preoperative and postoperative echocardiographic parameters, including strain measurements.

Methods

A retrospective cohort of 448 bicuspid SAVR patients from 2015–2021 was analyzed. Preoperative echocardiograms were obtained within 1 month before surgery, with follow-up at 6 months. Parameters assessed included standard measurements (e.g., stroke volume index [SVi], ejection fraction [EF], flow rate, and pressure gradients) and advanced strain metrics (e.g., global longitudinal strain [GLS], left atrial reservoir strain [LArS], and right ventricular free wall strain [RVFWS]). Mortality data were collected via national registry, with a median follow-up of 54.2 months.

Results

The median age was 59 years; 68.5% were male. The 30-day and 5-year mortality rates were 3.6% and 18.3%, respectively, both lower than the overall SAVR cohort. Preoperative parameters such as lower SVi (p = 0.027), EF (p = 0.045), flow rate (p = 0.027), and reduced strain measures (LArS, p < 0.001; LAcS, p = 0.013; RVFWS, p = 0.005) correlated with worse outcomes. Postoperative reductions in EF and SVi were observed, but only the change in mean pressure gradient (meanPG) was associated with 5-year mortality. Higher absolute LArS independently predicted improved survival (p < 0.001). Multivariate analysis identified hypertension, elevated urea, longer hospital stays, and higher preoperative LArS as independent predictors of mortality.

Conclusions

Bicuspid SAVR patients exhibit favorable medium-term survival, with 5-year mortality at 18.3%. Absolute preoperative LArS are a key independent predictor of outcomes, alongside clinical factors such as hypertension and urea levels. The reduction in meanPG postsurgery correlates with better long-term survival, emphasizing the importance of comprehensive echocardiographic assessment in risk stratification and management.

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超声心动图研究：二尖瓣主动脉瓣置换术：解剖学视角、中期5年预后和死亡率预测因素

背景/目的双尖瓣主动脉瓣（BAV）是外科主动脉瓣置换术（SAVR）的常见原因。本研究旨在评估双尖瓣SAVR患者的中期（5年）预后、超声心动图变化和死亡率预测因素，重点关注术前和术后超声心动图参数，包括应变测量。方法对2015-2021年448例双尖瓣SAVR患者进行回顾性队列分析。术前1个月内进行超声心动图检查，术后6个月随访。评估的参数包括标准测量（如卒中容积指数[SVi]、射血分数[EF]、流速和压力梯度）和高级应变测量（如总纵向应变[GLS]、左心房储液池应变[LArS]和右心室游离壁应变[RVFWS]）。死亡率数据通过国家登记收集，中位随访时间为54.2个月。结果中位年龄59岁；68.5%为男性。30天和5年死亡率分别为3.6%和18.3%，均低于总体SAVR队列。术前参数如较低的SVi （p = 0.027）、EF （p = 0.045）、流速（p = 0.027）和减小的应变测量（LArS, p < 0.001; LAcS, p = 0.013； RVFWS, p = 0.005）与较差的预后相关。观察到术后EF和SVi的降低，但只有平均压力梯度（meanPG）的变化与5年死亡率相关。较高的绝对LArS独立预测了生存率的提高（p < 0.001）。多变量分析发现高血压、尿素升高、住院时间较长和术前LArS较高是死亡率的独立预测因素。结论双尖瓣SAVR患者中期生存率较好，5年死亡率为18.3%。与高血压和尿素水平等临床因素一起，绝对术前LArS是预后的关键独立预测因素。术后平均pg的降低与较好的长期生存相关，强调了全面超声心动图评估在风险分层和管理中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.