Why bicuspid and tricuspid valve

Statistical analysis was performed with JMP 9. Continuous variables were tested for normality using the Shapiro—Wilk test. The majority of continuous variables were not normally distributed and thus were compared using the Wilcoxon rank sum test. Survival was computed using the Kaplan—Meier method and was compared between groups using the two-sample logrank test. Within each group, expected survival was computed based Minnesota death rates by age and gender and compared with expected using the one-sample logrank test.

Baseline patient demographic and clinical characteristics according to valve morphology are shown in Table 1. Overall, BAV patients were less likely to have multiple comorbidities, as measured by a CCI score of greater than 2 3 vs. Table 1 Baseline clinical characteristics. Echocardiographic characteristics are shown in Table 2.

Table 2 Baseline echocardiographic characteristics. Aortic valve prosthesis type and size are shown in Table 3. Mechanical valves Table 3 Aortic valve prosthesis type and size. Concomitant surgeries during AVR are shown in Table 4. Table 4 Cuncurrent aortic surgery at the time of aortic valve replacement.

Five-year survival following aortic valve replacement. Five-year survival compared with age-matched expected. The current study assessed the association of valve morphology to patient comorbidities, clinical profile at the time of AVR, and outcomes following AVR in a cohort of patients with severe AS.

The major findings were that after age-matching, patients with TAV compared with BAV stenosis had i more cardiovascular risk factors; ii greater degree of echocardiographic abnormalities; iii less prevalent associated aortopathy; iv smaller size prostheses implanted, and v lower than expected overall survival following AVR. A separate study of risk factors associated with the development of AS in BAV patients cautioned against extrapolation of the findings in CHS to BAV patients who typically develop AS at a younger age, but did find total cholesterol and hypertension to be risk factors.

Our current study extends the aforementioned findings and demonstrates atherosclerotic risk factors to be prevalent in both BAV and TAV stenoses without age difference where the majority of patients have associated cardiovascular risk factors.

The most common risk factors in both groups were hypertension and hyperlipidaemia. Diabetes was previously shown to be a risk factor for the development of AS 33 and in the current study was relatively common in the TAV compared with BAV group.

Overall, however, the prevalence of systemic cardiovascular risk factors was significantly lower in BAV compared with TAV stenosis, likely explained by the congenital predisposition for the development of AS in BAV.

Echocardiographically, despite similar degree of valve stenosis and higher transvalvular gradient in BAV stenosis, patients with TAV stenosis displayed greater degree of cardiac impairment with worse diastolic function, larger left atrial size, and more prevalent pulmonary hypertension, a finding not previously reported. Aortic valve prosthesis size, whether mechanical or bioprosthetic, was larger in the BAV group; patient prosthesis mismatch, known to be associated with poor survival following AVR, 41—44 was less common in BAV.

In this study, bioprostheses were associated with poor survivorship compared to mechanical valve prostheses. It is noteworthy that the observed survival following AVR for BAV stenosis was not different from age- and gender-matched expected survival.

Similar to our findings, a recent study by Masri et al. However, patients in our study population were older and the predominant pathology of the aortic valve was severe aortic valve stenosis, whereas Masri et al. This study is subject to the inherent bias of retrospective studies.

Because one of our main objectives was to compare cardiovascular comorbidities and their impact on outcomes following surgery, the two groups in our cohort were not propensity matched. TAV stenosis was associated with a greater prevalence of cardiovascular risk factors and a greater degree of cardiac impairment compared to patients of the same age with BAV stenosis.

Patients with BAV also had implanted prosthetic valves that were larger. Additional studies are needed to examine if aggressive cardiovascular risk factor management improves outcomes incrementally to AVR in a subset of patients with aortic valve stenosis, particularly those with TAV stenosis.

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Etiology of bicuspid aortic valve disease: focus on hemodynamics. The type of surgery done depends on your specific condition and symptoms. Aortic valve replacement. The surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue biological tissue valve. Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible.

Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood thinners for the rest of their lives to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you. After a bicuspid aortic valve has been diagnosed, you'll need lifelong doctor's checkups by a cardiologist to monitor for any changes in your condition.

If you have a bicuspid aortic valve, you are more likely to develop an infection of the lining of the heart infective endocarditis. Proper dental care can help lower your risk. A bicuspid aortic valve can be passed down in families inherited. Because of this, doctors often recommend that parents, children and siblings first-degree relatives of people with a bicuspid aortic valve be screened with an echocardiogram.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Bicuspid aortic valve Bicuspid aortic valve with stenosis Open pop-up dialog box Close. Bicuspid aortic valve with stenosis A bicuspid aortic valve is an aortic valve that has two flaps cusps instead of three.

Request an Appointment at Mayo Clinic. Biological valve replacement Open pop-up dialog box Close. Biological valve replacement In biological valve replacement, a valve made from cow, pig or human heart tissue replaces the damaged valve. Mechanical valve replacement Open pop-up dialog box Close.

Mechanical valve replacement In mechanical valve replacement, a mechanical valve replaces the damaged valve. Share on: Facebook Twitter. Show references Bonow RO, et al. Aortic valve disease. Elsevier; Accessed March 18, Heart valve disease.

National Heart, Lung, and Blood Institute. Aortic valve stenosis AVS and congenital defects. American Heart Association. Braverman AC. Clinical manifestations and diagnosis of bicuspid aortic valve in adults.

Bicuspid aortic valve: General management in adults.