title: The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy.
abstract: BACKGROUND
  Aortic stenosis may be related to coronary atherosclerosis in patients with tricuspid aortic valve, while aortic dilatation often is present in patients with bicuspid aortic valve. We sought to define associations among aortic stenosis, coronary atherosclerosis, and thoracic aortic aneurysm in patients with tricuspid or bicuspid aortic valve undergoing surgery for aortic stenosis in a large referral medical center.
  
  
  METHODS
  Two hundred seventy patients with severe aortic stenosis (tricuspid 175, bicuspid 95) undergoing surgical aortic valve replacement (AVR) were studied.
  
  
  RESULTS
  Coronary artery bypass grafting (CABG) surgery plus AVR was required more often in tricuspid compared to bicuspid aortic valve [62.2% versus 26.3%; p<0.0001; odds ratio 4.5, confidence interval (CI) 2.5-8.3]. The incidence of coronary atherosclerosis requiring CABG in bicuspid aortic valve (26.3%) was greater than that expected in the general population for similar age. Thoracic aorta surgery due to aortic aneurysm plus AVR was performed more often in bicuspid compared to tricuspid aortic valve (27.3% versus 3.4%; p<0.0001; odds ratio 7.7, CI 3.0-22.1). The incidence of ascending aorta aneurysm requiring surgery, however, was not more common in tricuspid aortic valve (3.4%) to that expected in the general population for similar age.
  
  
  CONCLUSIONS
  Incidence of coronary atherosclerosis is high in patients with aortic stenosis, both in those with tricuspid and bicuspid aortic valve. Incidence of ascending aortic aneurysm is high in patients with bicuspid, but not those with tricuspid aortic valve. These findings should be taken into consideration in the evaluation and management of patients with the aortic stenosis complex.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA. Electronic address: kdboudoulas@osumc.edu.
authors.forename: Konstantinos Dean
authors.initials: KD
authors.lastname: Boudoulas
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Wolfe
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Yazhini
authors.initials: Y
authors.lastname: Ravi
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Lilly
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Haikady N
authors.initials: HN
authors.lastname: Nagaraja
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Chittoor B
authors.initials: CB
authors.lastname: Sai-Sudhakar
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014261:Tricuspid Valve / Q000601:surgery
keywords: Aortic aneurysm; Aortic stenosis; Bicuspid valve; Coronary artery disease; Tricuspid valve