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Dolmaci OB, Hilhorst TL, Malekzadeh A, Mertens BJA, Klautz RJM, Poelmann RE, Grewal N. The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature. AORTA (STAMFORD, CONN.) 2024. [PMID: 38698623 DOI: 10.1055/s-0044-1785190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Tijmen L Hilhorst
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjan Malekzadeh
- Medical Library, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Bart J A Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Leiden University, Sylvius Laboratory, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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West TM, Howsmon DP, Massidda MW, Vo HN, Janobas AA, Baker AB, Sacks MS. The effects of strain history on aortic valve interstitial cell activation in a 3D hydrogel environment. APL Bioeng 2023; 7:026101. [PMID: 37035541 PMCID: PMC10076067 DOI: 10.1063/5.0138030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
Aortic valves (AVs) undergo unique stretch histories that include high rates and magnitudes. While major differences in deformation patterns have been observed between normal and congenitally defective bicuspid aortic valves (BAVs), the relation to underlying mechanisms of rapid disease onset in BAV patients remains unknown. To evaluate how the variations in stretch history affect AV interstitial cell (AVIC) activation, high-throughput methods were developed to impart varied cyclical biaxial stretch histories into 3D poly(ethylene) glycol hydrogels seeded with AVICs for 48 h. Specifically, a physiologically mimicking stretch history was compared to two stretch histories with varied peak stretch and stretch rate. Post-conditioned AVICs were imaged for nuclear shape, alpha smooth muscle actin (αSMA) and vimentin (VMN) polymerization, and small mothers against decapentaplegic homologs 2 and 3 (SMAD 2/3) nuclear activity. The results indicated that bulk gel deformations were accurately transduced to the AVICs. Lower peak stretches lead to increased αSMA polymerization. In contrast, VMN polymerization was a function of stretch rate, with SMAD 2/3 nuclear localization and nuclear shape also trending toward stretch rate dependency. Lower than physiological levels of stretch rate led to higher SMAD 2/3 activity, higher VMN polymerization around the nucleus, and lower nuclear elongation. αSMA polymerization did not correlate with VMN polymerization, SMAD 2/3 activity, nor nuclear shape. These results suggest that a negative feedback loop may form between SMAD 2/3, VMN, and nuclear shape to maintain AVIC homeostatic nuclear deformations, which is dependent on stretch rate. These novel results suggest that AVIC mechanobiological responses are sensitive to stretch history and provide insight into the mechanisms of AV disease.
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Affiliation(s)
- Toni M. West
- James T. Willerson Center for Cardiovascular Modelling and Simulation, Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, Austin, Texas 78711, USA
| | - Daniel P. Howsmon
- James T. Willerson Center for Cardiovascular Modelling and Simulation, Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, Austin, Texas 78711, USA
| | - Miles W. Massidda
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78711, USA
| | | | | | - Aaron B. Baker
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78711, USA
| | - Michael S. Sacks
- James T. Willerson Center for Cardiovascular Modelling and Simulation, Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, Austin, Texas 78711, USA
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Jahangiri M, Bilkhu R, Embleton-Thirsk A, Dehbi HM, Mani K, Anderson J, Avlonitis V, Baghai M, Birdi I, Booth K, Bose A, Briffa N, Buchan K, Bhudia S, Cale A, Deglurkar I, Farid S, Hadjinikolaou L, Jarvis M, Javadpour SH, Jeganathan R, Kuduvalli M, Lall K, Mascaro J, Mehta D, Ohri S, Punjabi P, Venkateswaran R, Ridley P, Satur C, Stoica S, Trivedi U, Zaidi A, Yiu P, Moorjani N, Kendall S, Freemantle N. Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database. BMJ Open 2021; 11:e046491. [PMID: 34711589 PMCID: PMC8557283 DOI: 10.1136/bmjopen-2020-046491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore 'real-world' practice. DESIGN Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. SETTING 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. PARTICIPANTS 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. RESULTS In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60-75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. CONCLUSIONS Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
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Affiliation(s)
| | - Rajdeep Bilkhu
- Department of Cardiac Surgery, St Thomas' Hospital, London, UK
| | | | - Hakim-Moulay Dehbi
- University College London Institute of Clinical Trials and Methodology, London, UK
| | - Krishna Mani
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Jon Anderson
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Max Baghai
- Department of Cardiac Surgery, King's College Hospital, London, UK
| | - Inderpaul Birdi
- Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
| | - Karen Booth
- Department of Cardiac Surgery, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Amal Bose
- Department of Cardiac Surgery, Lancashire Cardiac Centre, Blackpool, UK
| | - Norman Briffa
- Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre, Sheffield, UK
| | - Keith Buchan
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Alex Cale
- Department of Cardiac Surgery, Castle Hill Hospital, Cottingham, UK
| | - Indu Deglurkar
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Shakil Farid
- Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Leonidas Hadjinikolaou
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin Jarvis
- Department of Cardiac Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Kulvinder Lall
- Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Jorge Mascaro
- Department of Cardiac Surgery, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Dheeraj Mehta
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Prakash Punjabi
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Paul Ridley
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Christopher Satur
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Uday Trivedi
- Royal Sussex County Hospital Sussex Cardiac Centre, Brighton, UK
| | - Afzal Zaidi
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Patrick Yiu
- Department of Cardiac Surgery, New Cross Hospital, Wolverhampton, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Simon Kendall
- Department of Cardiac Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London Institute of Clinical Trials and Methodology, London, UK
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Dolmaci OB, Driessen AHG, Klautz RJM, Poelmann R, Lindeman JHN, Grewal N. Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective. Open Heart 2021; 8:openhrt-2021-001772. [PMID: 34497063 PMCID: PMC8438949 DOI: 10.1136/openhrt-2021-001772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/30/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) has been associated with less atherosclerosis as compared with tricuspid aortic valve (TAV) patients. It, however, remains unclear whether this reflects the older age of TAV patients and/or accumulation of atherosclerotic risk factors or that the BAV phenotype is atheroprotective. Therefore, we compared the atherosclerotic disease burden of BAV and TAV patients, with that of the general (age-matched) population. METHODS The prevalence of coronary artery disease (CAD) and CAD risk factors in BAV and TAV patients who underwent aortic valve surgery were compared with the Dutch general practitioners registry data. BAV (n=454) and TAV (n=1101) patients were divided into four groups: BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS) and TAV with AR (TAV-AR). The atherosclerotic disease burden of each group was compared with that of the corresponding age cohort for the general population. RESULTS CAD risk factors hypertension and hypercholesterolaemia were more prevalent in the surgery groups than the age-matched general population (all p<0.001). All BAVs (BAV-AoS and BAV-AR) and TAV-AR had a similar incidence of CAD history as compared to the age-matched general populations (p=0.689, p=0.325 and p=0.617 respectively), whereas TAV-AoS had a higher incidence (21.6% versus 14.9% in the age-matched general population, p<0.001). CONCLUSIONS Stenotic TAV disease is part of the atherosclerotic disease spectrum, while regurgitant TAV and all BAVs are not. Although the prevalence of cardiovascular risk factors is higher in all BAV patients, the prevalence of CAD is similar to the general population.
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Affiliation(s)
- Onur Baris Dolmaci
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Robert J M Klautz
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Robert Poelmann
- Animal Sciences and Health, Leiden University Institute of Biology, Leiden, The Netherlands
| | - Jan H N Lindeman
- Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands .,Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Çelik M, Milojevic M, Durko AP, Oei FBS, Bogers AJJC, Mahtab EAF. Differences in baseline characteristics and outcomes of bicuspid and tricuspid aortic valves in surgical aortic valve replacement. Eur J Cardiothorac Surg 2021; 59:1191-1199. [PMID: 33496318 DOI: 10.1093/ejcts/ezaa474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/14/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with bicuspid aortic valve (BAV) comprise a substantial portion of patients undergoing surgical aortic valve replacement (SAVR). Our goal was to quantify the prevalence of BAV in the current SAVR ± coronary artery bypass grafting (CABG) population, assess differences in cardiovascular risk profiles and assess differences in long-term survival in patients with BAV compared to patients with tricuspid aortic valve (TAV). METHODS Patients who underwent SAVR with or without concomitant CABG and who had a surgical report denoting the relevant valvular anatomy were eligible and included. Prevalence, predictors and outcomes for patients with BAV were analysed and compared to those patients with TAV. Matched patients with BAV and TAV were compared using a propensity score matching strategy and an age matching strategy. RESULTS A total of 3723 patients, 3145 of whom (mean age 66.6 ± 11.4 years; 37.4% women) had an operative report describing their aortic valvular morphology, underwent SAVR ± CABG between 1987 and 2016. The overall prevalence of patients with BAV was 19.3% (607). Patients with BAV were younger than patients with TAV (60.6 ± 12.1 vs 68.0 ± 10.7, respectively). In the age-matched cohort, patients with BAV were less likely to have comorbidities, among others diabetes (P = 0.001), hypertension (P < 0.001) and hypercholesterolaemia (P = 0.003), compared to patients with TAV. Twenty-year survival following the index procedure was higher in patients with BAV (14.8%) compared to those with TAV (12.9%) in the age-matched cohort (P = 0.015). CONCLUSIONS Substantial differences in the cardiovascular risk profile exist in patients with BAV and TAV. Long-term survival after SAVR in patients with BAV is satisfactory.
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Affiliation(s)
- Mevlüt Çelik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Sia CH, Ho JSY, Chua JJL, Tan BYQ, Ngiam NJ, Chew N, Sim HW, Chen R, Lee CH, Yeo TC, Kong WKF, Poh KK. Comparison of Clinical and Echocardiographic Features of Asymptomatic Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves. Am J Cardiol 2020; 128:210-215. [PMID: 32534732 DOI: 10.1016/j.amjcard.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/31/2022]
Abstract
The clinical and imaging differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with medically managed asymptomatic moderate-to-severe aortic stenosis (AS) have not been studied previously. We aim to characterize these differences and their clinical outcomes in this study. A retrospective observational study was conducted on 836 consecutive cases of isolated asymptomatic moderate-to-severe AS, with median follow-up of 3.4 years. Clinical and echocardiographic characteristics were compared between BAV and TAV patients. Subgroup analysis stratified by AS severity were performed. Survival analysis of all-cause mortality was performed using Kaplan-Meier curves and Cox proportional hazards model. Compared to BAV patients, TAV patients were older (76 ± 11 vs 55 ± 16 years, p <0.001) and had more co-morbidities including hypertension (78% vs 56%; p <0.001), diabetes (41% vs 24%; p <0.001), and chronic kidney disease (20% vs 3%; p = 0.001). TAV patients had less severe aortic valve disease than BAV patients, with a higher aortic valve area index (0.71 ± 0.20 cm2/m2 vs 0.61 ± 0.18 cm2/m2, p <0.001) and less aortic dilation (sinotubular junction: 23.7 ± 4.0 mm vs 26.9 ± 4.8 mm, p <0.001; mid-ascending aorta: 31.4 ± 4.7 mm vs 36.3 ± 6.3 mm, p <0.001). TAV patients were more likely to have eccentric left ventricular hypertrophy and less likely to have a normal geometry (p = 0.003). Competing risk analysis identified increased age (hazard ratio 1.03, 95% confidence interval 1.02 to 1.05, p <0.001) and LVEF (hazard ratio 0.98, 95% confidence interval 0.97 to 0.99, p <0.001) as independent risk factors of all-cause mortality. Valve morphology was not a significant independent risk factor for aortic valve replacement or mortality. In conclusion, asymptomatic TAV patients had more cardiovascular risk factors, less severe aortic valve disease, less sinotubular and mid-ascending aortic dilation, more severe LV remodeling.
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