title: Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta-Analysis.
abstract: Literature studies suggested a lower prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid aortic valve (TAV) patients. However, this finding has been challenged. We performed a meta-analysis to assess whether aortic valve morphology has a different association with CAD, concomitant coronary artery bypass grafting (CABG), and postoperative mortality.
  
  
  
  Detailed search was conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline to identify all patients with BAV or TAV and presence of CAD, concomitant myocardial surgical revascularization, and the postoperative mortality. Thirty-one studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery were included. BAV patients showed a lower prevalence of CAD (odds ratio [OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35, 0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than TAV. However, BAV subjects were significantly younger than TAV (mean difference: -7.29; 95% CI: -11.17, -3.41) were more frequently males (OR, 1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension (OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54, 0.93). Interestingly, a metaregression analysis showed that younger age and lower prevalence of diabetes were associated with lower prevalence of CAD (Z value: -3.03; P=0.002 and Z value: -3.10; P=0.002, respectively) and CABG (Z value: -2.69; P=0.007 and Z value: -3.36; P=0.001, respectively) documented in BAV patients.
  
  
  
  Analysis of raw data suggested an association of aortic valve morphology with prevalence of CAD, concomitant CABG, and postoperative mortality. Interestingly, the differences in age and diabetes have a profound impact on prevalence of CAD between BAV and TAV. In conclusion, our meta-analysis suggests that the presence of CAD is independent of aortic valve morphology.
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy paolo.poggio@ccfm.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Poggio
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy Dipartimento di Medicina e Chirurgia, University of Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cavallotti
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Songia
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Minno
authors.affiliation: Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambrosino
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy Dipartimento di Medicina e Chirurgia, University of Milan, Italy.
authors.forename: Liborio
authors.initials: L
authors.lastname: Mammana
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Italy Unità Operativa di Cardiochirurgia e Ricerca Traslazionale, San Donato IRCCS, San Donato Milanese, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy Dipartimento di Medicina e Chirurgia, University of Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
mesh_terms: D001021:Aortic Valve / Q000002:abnormalities*; D000082882:Bicuspid Aortic Valve Disease; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000453:epidemiology*; D006801:Humans; D009026:Mortality; D015995:Prevalence; D011379:Prognosis; D012044:Regression Analysis
keywords: aortic valve morphology; bicuspid aortic valve; coronary artery disease