The effect of bicuspid aortic valve versus tricuspid aortic valve as a risk factor for aortic dilatation: a systematic review and meta-analysis
Main Article Content
Keywords
bicuspid aortic valve, tricuspid aortic valve, aortic dilatation
Abstract
Background: The enlargement of the ascending aorta (AA) is a frequent finding in clinical practice. Age, gender, and body size have been shown to be important determinants of AA diameter. One of the most prevalent congenital heart conditions is bicuspid aortic valve (BAV) disease, which primarily affects male subjects and has a population prevalence of 0.5% to 2.0%. Purely severely stenotic BAVs developed a moderate dilation of the aorta at an early age, while TAVs (Tricuspid Aortic Valves) did not. This study aims to compare BAV and TAV as risk factors for aortic dilatation.
Methods: A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using PubMed/Medline, Scopus, and ScienceDirect databases according to PICO. The studies obtained were adjusted to the eligibility criteria. We conducted a journal appraisal assessment using the CASP 2024 tools for the 10 included studies. Meta-analysis was performed using Review Manager 5.4.
Result: Out of 208 studies, 10 studies are included for a systematic review according to eligibility criteria. From the baseline characteristics, BAV with aortic dilatation is often seen at a younger age compared to TAV. 5 studies are analyzed for the incidence risk of aortic dilatation between BAV and TAV group (OR 5.16; 95% CI 2.69, 9.92; p<0.001) and 6 studies are analyzed for the aortic diameter between BAV and TAV group (OR 0.55; 95% CI -1.37, 2.46; p<0.58).
Conclusion: Our systematic review-meta-analysis study found that there is an increase in ithe ncidence risk of aortic dilatation in BAV patients compared to TAV patients. Our study result supports the guideline designed by the American Association for Thoracic Surgery that suggests patients undergoing concurrent heart surgery, concomitant ascending aorta/root repair should be actively performed when the aortic diameter is 45 mm.
References
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3. Wang J, Deng W, Lv Q, Li Y, Liu T, Xie M. Aortic Dilatation in Patients With Bicuspid Aortic Valve. Front Physiol. 2021;12:615175. Available from: https://pubmed.ncbi.nlm.nih.gov/34295254
4. Fujiwara J, Orii M, Takagi H, Chiba T, Sasaki T, Tanaka R, et al. Aortic Elongation in Bicuspid Aortic Valve with Aortic Stenosis Assessed by Thin-Slice Electrocardiogram-Gated Computed Tomography. Int Heart J. 2022;63(2):319–26. Available from: http://dx.doi.org/10.1536/ihj.21-244
5. Yasuda H, Nakatani S, Stugaard M, Tsujita-Kuroda Y, Bando K, Kobayashi J, et al. Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve. Circulation. 2003;108(10_suppl_1). Available from: http://dx.doi.org/10.1161/01.cir.0000087449.03964.fb
6. Swahn E, Lekedal H, Engvall J, Nyström FH, Jonasson L. Prevalence and determinants of dilated ascending aorta in a Swedish population: a case-control study. Eur Hear J open. 2023;3(5):oead085–oead085. Available from: https://pubmed.ncbi.nlm.nih.gov/37767013
7. Kassis N, Saad AM, Ahuja KR, Gad MM, Abdelfattah OM, Isogai T, et al. Impact of thoracic aortic aneurysm on outcomes of transcatheter aortic valve replacement: A nationwide cohort analysis. Catheter Cardiovasc Interv. 2020;97(3):549–53. Available from: http://dx.doi.org/10.1002/ccd.29195
8. Heng E, Stone JR, Kim JB, Lee H, MacGillivray TE, Sundt TM. Comparative Histology of Aortic Dilatation Associated With Bileaflet Versus Trileaflet Aortic Valves. Ann Thorac Surg. 2015;100(6):2095–101. Available from: http://dx.doi.org/10.1016/j.athoracsur.2015.05.105
9. Boudoulas KD, Wolfe B, Ravi Y, Lilly S, Nagaraja HN, Sai-Sudhakar CB. The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy. J Cardiol. 2015;65(5):377–82. Available from: http://dx.doi.org/10.1016/j.jjcc.2014.12.021
10. Nakamura Y, Ryugo M, Shikata F, Okura M, Okamura T, Yasugi T, et al. The analysis of ascending aortic dilatation in patients with a bicuspid aortic valve using the ratio of the diameters of the ascending and descending aorta. J Cardiothorac Surg. 2014;9:108. Available from: https://pubmed.ncbi.nlm.nih.gov/24947564
11. Billaud M, Phillippi JA, Kotlarczyk MP, Hill JC, Ellis BW, St Croix CM, et al. Elevated oxidative stress in the aortic media of patients with bicuspid aortic valve. J Thorac Cardiovasc Surg. 2017/05/25. 2017;154(5):1756–62. Available from: https://pubmed.ncbi.nlm.nih.gov/28651938
12. Jackson V, Eriksson MJ, Caidahl K, Eriksson P, Franco-Cereceda A. Ascending aortic dilatation is rarely associated with coronary artery disease regardless of aortic valve morphology. J Thorac Cardiovasc Surg. 2014;148(6):2973-2980.e1. Available from: http://dx.doi.org/10.1016/j.jtcvs.2014.08.023
13. Haunschild J, Schellinger IN, von Salisch S, Bakhtiary F, Misfeld M, Mohr FW, et al. Granular Media Calcinosis in the Aortic Walls of Patients With Bicuspid and Tricuspid Aortic Valves. Ann Thorac Surg. 2017;103(4):1178–85. Available from: http://dx.doi.org/10.1016/j.athoracsur.2016.07.018
14. Singh A, Horsfield MA, Bekele S, Greenwood JP, Dawson DK, Berry C, et al. Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves. Eur Radiol. 2018/11/28. 2019;29(5):2340–9. Available from: https://pubmed.ncbi.nlm.nih.gov/30488106
15. Yuan S-M, Jing H, Lavee J. The bicuspid aortic valve and its relation to aortic dilation. Clinics (Sao Paulo). 2010;65(5):497–505. Available from: https://pubmed.ncbi.nlm.nih.gov/20535368
16. Michelena HI, Khanna AD, Mahoney D, Margaryan E, Topilsky Y, Suri RM, et al. Incidence of Aortic Complications in Patients With Bicuspid Aortic Valves. JAMA. 2011;306(10):1104. Available from: http://dx.doi.org/10.1001/jama.2011.1286
17. Chironi G, Orobinskaia L, Mégnien J-L, Sirieix M-E, Clément-Guinaudeau S, Bensalah M, et al. Early thoracic aorta enlargement in asymptomatic individuals at risk for cardiovascular disease: determinant factors and clinical implication. J Hypertens. 2010;28(10):2134–8. Available from: http://dx.doi.org/10.1097/hjh.0b013e32833cd276
18. Keane MG, Wiegers SE, Plappert T, Pochettino A, Bavaria JE, Sutton MGSJ. Bicuspid Aortic Valves Are Associated With Aortic Dilatation Out of Proportion to Coexistent Valvular Lesions. Circulation. 2000;102(suppl_3). Available from: http://dx.doi.org/10.1161/circ.102.suppl_3.iii-35
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Author Biographies
Rama Azalix Rianda, Cardiothoracic and Vascular Surgery Department, Faculty of Medicine, Universitas Indonesia
Cardiothoracic and Vascular Surgery Department, Faculty of Medicine, Universitas Indonesia
Ivan Danindra, Cardiothoracic and Vascular Surgery Department, Faculty of Medicine, Universitas Indonesia
Cardiothoracic and Vascular Surgery Department, Faculty of Medicine, Universitas Indonesia
Dicky Aligheri Wartono, Cardiothoracic and Vascular Surgery Department, Faculty of Medicine, Universitas Indonesia
Cardiothoracic and Vascular Surgery Department, Faculty of Medicine, Universitas Indonesia