17. Long term durability of bioprosthetic aortic valve replacement in young patients with bicuspid aortic stenosis

Objective: The optimal initial procedure approach, surgical or transcatheter, is controversial for patients with bicuspid aortic valve (BAV) considering lifetime management of aortic stenosis (AS) in these younger patients. We sought to establish a long-term surgical aortic valve replacement (SAVR) benchmark for young (<65 years) BAV patients with AS.
Methods: Using institutional data from 2004-2022, 498 BAV patients less than 65 underwent SAVR for AS with bioprosthetic valves with or without aneurysm repair (SAVR vs. SAVR/AN). We examined operative outcomes, long term valve durability and reintervention in those with TAVR potential, isolated AS without aneurysm, to those in whom surgical intervention would be preferred, AS and an aneurysm.
Results: The total cohort comprised 281 isolated SAVR patients and 217 with concomitant aneurysm repair (SAVR/AN). The average age was 55 ± 8 years, with STS PROM: 0.8 and mean valve size: 25mm, which increased over time. Operative mortality (0.7% vs. 1.4%) was similar between SAVR and SAVR/AN patients. Predischarge permanent pacemaker implantation occurred in 1.6% (n=8/498) patients. During follow-up (5.9 ± 4.9 years; range: 0.2, 18.2 years), the cumulative incidence of reintervention at 10 years for structural valve degeneration (n=33) including Valve-in-Valve (ViV; n=15) was 6.6% (8.1% SAVR vs. 4.5% SAVR/AN, p=0.66). No mortality was observed for ViV or redo-SAVR. Average AV gradient at follow up increased over time and was 12.8 ± 8.7 overall, and higher in the SAVR only group (13.7 ± 8.8 vs. 11.7 ± 8.4). Using linear mixed modeling to account for repeated measurements, patients who underwent aneurysm repair had a lower average mean gradient (1.9 less than SAVR Only, p<0.05) compared to those without aneurysm repair throughout the follow up period. Moderate or greater aortic regurgitation and paravalvular leak were observed in 6.5% and 0.3% respectively at most recent follow-up.
Conclusion: Bioprosthetic valve replacement for bicuspid valve aortic stenosis in young patients is a very safe procedure, with low need for pacemaker and excellent durability. Current use of large diameter, and/or expandable valves, should allow for the routine use of valve-in-valve when needed. These results support initial SAVR when considering lifetime management of aortic stenosis.

Tom Liu (1), Christopher Mehta (1), Abigail Baldridge (2), Jane Kruse (1), Jyothy Puthumana (1), Robert Bonow (1), Duc Thinh Pham (1), Douglas Johnston (1), S. Chris Malaisrie (1), Patrick McCarthy (1), (1) Northwestern Memorial Hospital, Chicago, IL, (2) Northwestern University, Chicago, IL

Kendra Grubb

Commentator

Dr. Kendra J. Grubb, MD, MHA, FACC, Surgical Director Emory University Structural Heart and Valve Center, is dedicated to improving the lives of patients through innovation and building collaborative teams to promote patient-centered treatment of cardiovascular disease. Previously, she was Director of Minimally Invasive Cardiac Surgery and the Heart Valve Program at University of Louisville.
Dr. Grubb has led and participated in numerous clinical trials of innovative technologies, including studies of transcatheter aortic valve replacement, mitral valve percutaneous therapies, endovascular treatment of descending thoracic aortic aneurysms, and transcatheter heart failure devices.
Dr. Grubb attended University of Southern California, where she received her MD degree from Keck School of Medicine and her Master of Health Administration. She completed general surgery residency at University of Illinois at Chicago (2010), fellowship in cardiothoracic surgery at University of Virginia (2012), and fellowship in interventional cardiology and transcatheter therapies at New York Presbyterian-Columbia University (2013).

 

Christopher Mehta

Abstract Presenter

Assistant Professor of Surgery
Division of Cardiac Surgery
Associate Director, Thoracic Aortic Surgery
Northwestern Medicine