title: Clinical outcome and echocardiographic predictors of aortic valve replacement in patients with bicuspid aortic valve.
abstract: BACKGROUND
  Clinical outcomes and echocardiographic parameters associated with aortic valve replacement (AVR) for bicuspid aortic valve are scarce.
  
  
  METHODS
  We conducted retrospective analysis of 208 adults with bicuspid aortic valve referred for transthoracic echocardiograms.
  
  
  RESULTS
  The Kaplan-Meier survival free of death or need for cardiac surgery was 72% at 5 years. Cardiac surgery was performed in 19%, the majority (68%) for symptomatic aortic stenosis. Peak gradient 80 mm Hg or greater (hazard ratio 11.8, 95% confidence interval 3.7-37.8, P < .0001) and aortic valve area less than or equal to 0.75 cm(2) (hazard ratio 2.9, 95% confidence interval 1.0-8.5, P = .05) predicted the need for AVR. Patients with a large (54%) versus normal left ventricular outflow tract dimension underwent AVR for symptomatic aortic stenosis at a larger calculated aortic valve area (1.07 +/- 0.21 vs 0.75 +/- 0.18 cm(2), P < .0001) but at a similar peak gradient and velocity ratio (76 +/- 19 vs 76 +/- 22 mm Hg, P = not significant; 0.23 +/- 0.06 vs 0.26 +/- 0.12, P = not significant, respectively).
  
  
  CONCLUSIONS
  Clinical events are common among patients with bicuspid aortic valve. Peak gradient 80 mm Hg or more and aortic valve area less than or equal to 0.75 cm(2) predicts the need for AVR. Gradients and velocity ratio better reflect the hemodynamic burden of aortic stenosis in patients with a large left ventricular outflow tract.
authors.affiliation: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Shaheeda
authors.initials: S
authors.lastname: Ahmed
authors.forename: George N
authors.initials: GN
authors.lastname: Honos
authors.forename: Anne D
authors.initials: AD
authors.lastname: Walling
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Michel
authors.forename: Igal A
authors.initials: IA
authors.lastname: Sebag
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Rudski
authors.forename: Judith
authors.initials: J
authors.lastname: Therrien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome