JAMA: Aortic valve disorder leads to cardiac eventsno change in survival rates

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Young adults with a bicuspid aortic valve experience subsequent cardiac events, but do not appear to have lower survival rates compared to the general population, according to a study in the Sept. 17 issue of the Journal of the American Medical Association.

Prior studies have reported significant death and illness in patients with bicuspid aortic valve related to the development of aortic valve dysfunction and inflammation of the heart valves, according to background information in the article. Cardiac outcomes in a contemporary population of adults with bicuspid aortic valve have not been determined.

Nikolaos Tzemos, MD, of the University of Toronto, and Samuel C. Siu, MD, of the University of Western Ontario in London, Ontario, and colleagues examined the cardiac outcomes and disease progression in 642 adults, (average age 35 years), with bicuspid aortic valve who were followed for an average of nine years.
One or more primary cardiac events occurred in 25 percent of patients, which included intervention on aortic valve or ascending aorta in 22 percent of patients, aortic tearing or aneurysm in 2 percent of patients, or congestive heart failure requiring hospital admission in 2 percent of patients, according to the researchers.

“Young adults with bicuspid aortic valve have a high likelihood of eventually requiring interventions on the aortic valve and/or aorta and will need serial surveillance of aortic valve and aortic dimensions,” the authors wrote.

They found that the independent predictors of primary cardiac events were older than age 30 with moderate/severe aortic narrowing and moderate/severe aortic regurgitation.

According to Tzemos and colleagues, there was a total of 28 deaths, of which 17 were cardiac-related and 11 were not related to a cardiac cause. The cardiac death rate was 0.3 percent per patient-year of follow-up.

When compared with age- and sex-matched population estimates, the researchers found that overall mortality was not significantly different between the bicuspid aortic valve group and in the population estimates. The five-year average survival was 97 percent in both the bicuspid aortic valve group and in the population estimates. The 10-year survival was similar in both the bicuspid aortic valve group (96 percent) and in the population estimates (97 percent).

“Outcome differences between present and prior studies can be attributed to differences in the era that patients were examined, the population that was examined, the frequency of cardiac events associated with high mortality (aortic [tearing] and endocarditis) and advances in perioperative management,” the authors wrote.