title: Incidence of aortic complications in patients with bicuspid aortic valves.
abstract: BACKGROUND
  Bicuspid aortic valve (BAV), the most common congenital heart defect, has been thought to cause frequent and severe aortic complications; however, long-term, population-based data are lacking.
  
  
  OBJECTIVE
  To determine the incidence of aortic complications in patients with BAV in a community cohort and in the general population.
  
  
  METHODS
  In this retrospective cohort study, we conducted comprehensive assessment of aortic complications of patients with BAV living in a population-based setting in Olmsted County, Minnesota. We analyzed long-term follow-up of a cohort of all Olmsted County residents diagnosed with definite BAV by echocardiography from 1980 to 1999 and searched for aortic complications of patients whose bicuspid valves had gone undiagnosed. The last year of follow-up was 2008-2009.
  
  
  METHODS
  Thoracic aortic dissection, ascending aortic aneurysm, and aortic surgery.
  
  
  RESULTS
  The cohort included 416 consecutive patients with definite BAV diagnosed by echocardiography, mean (SD) follow-up of 16 (7) years (6530 patient-years). Aortic dissection occurred in 2 of 416 patients; incidence of 3.1 (95% CI, 0.5-9.5) cases per 10,000 patient-years, age-adjusted relative-risk 8.4 (95% CI, 2.1-33.5; P = .003) compared with the county's general population. Aortic dissection incidences for patients 50 years or older at baseline and bearers of aortic aneurysms at baseline were 17.4 (95% CI, 2.9-53.6) and 44.9 (95% CI, 7.5-138.5) cases per 10,000 patient-years, respectively. Comprehensive search for aortic dissections in undiagnosed bicuspid valves revealed 2 additional patients, allowing estimation of aortic dissection incidence in bicuspid valve patients irrespective of diagnosis status (1.5; 95% CI, 0.4-3.8 cases per 10,000 patient-years), which was similar to the diagnosed cohort. Of 384 patients without baseline aneurysms, 49 developed aneurysms at follow-up, incidence of 84.9 (95% CI, 63.3-110.9) cases per 10,000 patient-years and an age-adjusted relative risk 86.2 (95% CI, 65.1-114; P <.001 compared with the general population). The 25-year rate of aortic surgery was 25% (95% CI, 17.2%-32.8%).
  
  
  CONCLUSIONS
  In the population of patients with BAV, the incidence of aortic dissection over a mean of 16 years of follow-up was low but significantly higher than in the general population.
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. michelena.hector@mayo.edu
authors.forename: Hector I
authors.initials: HI
authors.lastname: Michelena
authors.forename: Amber D
authors.initials: AD
authors.lastname: Khanna
authors.forename: Douglas
authors.initials: D
authors.lastname: Mahoney
authors.forename: Edit
authors.initials: E
authors.lastname: Margaryan
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Ben
authors.initials: B
authors.lastname: Eidem
authors.forename: William D
authors.initials: WD
authors.lastname: Edwards
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000453:epidemiology* / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology; D001014:Aortic Aneurysm / Q000453:epidemiology* / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk