Temporal Trends in Etiology of Aortic Valvular Diseases for Patients Undergoing Surgical Valve Replacement: A Report From 40 Years Pathological Experience.

Although aortic valvular disease has various etiologies, recently, calcific aortic valve stenosis has been increasing. We analyzed the trends in the pathological characteristics of aortic valvular disease in the past four decades in Japan. The pathology department data for aortic valvular disease operated in our hospital documented 4508 patients from 1978 to 2022. Subsequently, trend analyses were performed over four periods: Period 1, 1978-1989 (618 cases); Period 2, 1990-1999 (903 cases); Period 3, 2000-2010 (1179 cases); and Period 4, 2011-2022 (1808 cases). We reviewed the pathological characterization of the resected aortic valves and categorized them based on the representative etiology of aortic valvular disease as congenital bicuspid, chronic rheumatic change, infective endocarditis, degenerative calcific change, and myxoid change. Our pathologic analysis revealed a significant decrease in the proportion of chronic rheumatic disease from 47% to 14%, an increase in the congenital bicuspid valve from 8% to 24%, and a rise of the degenerative calcific change of the aortic valve from 4% to 27% (p < 0.001), especially significant increases in aortic stenosis. Calcification of the aortic valve may result from an active process similar to atherosclerosis, leading to aortic stenosis with increasing dyslipidemia in Japanese patients in 40 years.