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You are here: Contents > 2016 > Volume 25 Number 3 May 2016 > AORTIC VALVE DISEASE > Aortopathy in Bicuspid Aortic Valve Stenosis with Fusion of Right-Left versus Right-Non-Coronary Cusps: Are These Different Diseases?

Aortopathy in Bicuspid Aortic Valve Stenosis with Fusion of Right-Left versus Right-Non-Coronary Cusps: Are These Different Diseases?

Evaldas Girdauskas1,6, Mina Rouman2, Kushtrim Disha2, Georg Dubslaff3, Beatrix Fey3, Bernhard Theis4, Iver Petersen4, Michael A. Borger5, Yskert von Kodolitsch1, Thomas Kuntze2, Hermann Reichenspurner1

1Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany
2Department of Cardiac Surgery, Central Hospital Bad Berka, Germany
3Department of Radiology, Central Hospital Bad Berka, Germany
4Institute of Pathology, Friedrich-Schiller University Jena, Germany
5Columbia University Medical Center, New York, USA
6Electronic correspondence: e.girdauskas@uke.de

Background and aim of the study: The study aim was to prospectively analyze the impact of cusp fusion pattern on aortopathy severity in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis.

Methods: A total of 137 consecutive patients with BAV stenosis (93 males, 44 females; mean age 61 ± 9 years) underwent aortic valve replacement with or without concomitant aortic surgery between January 2012 and March 2015. All patients underwent preoperative cardiac magnetic resonance imaging (cMRI) in order to evaluate morphological/functional parameters of the aortic root. Fusion of the right-left coronary cusps was identified in 99 patients (72%) (R/L group), while the remaining 38 patients (28%) had right-noncoronary cusp fusion (R/N group). cMRI data were used to guide sampling of the proximal aorta during surgery. The expression/severity of aortopathy was quantified by means of proximal aortic phenotype, indexed aortic diameter, and a histological sum-score.


Results: There were no significant differences in proximal aortic diameter between the R/L and R/N groups. Moreover, there was no significant difference in the prevalence of distinct aortic phenotypes between the study subgroups. The histological sumscore was comparable between the R/L and R/N groups (2.9 ± 1.5 versus 2.5 ± 1.1, p = 0.2). The angle LV/aorta was significantly larger in the R/L group than in the R/N group (52.1 ± 10.6° versus 45.1 ± 8.5°, p = 0.001). Logistic regression analysis demonstrated the angle LV/aorta and the angle jet/aorta to be predictive of a mid-ascending phenotype. The cusp fusion pattern had no significant impact on the occurrence of aortic phenotype.

Conclusion: The study results demonstrated that cusp fusion morphotype has no significant impact on the expression and severity of bicuspid aortopathy in patients undergoing surgery for BAV stenosis.

The Journal of Heart Valve Disease 2016;25:262-269


Aortopathy in Bicuspid Aortic Valve Stenosis with Fusion of Right-Left versus Right-Non-Coronary Cusps: Are These Different Diseases?

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