title: Aortopathy in Bicuspid Aortic Valve Stenosis with Fusion of Right-Left versus Right-Non-Coronary Cusps: Are These Different Diseases?
abstract: The study aim was to prospectively analyze the impact of cusp fusion pattern on aortopathy severity in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis.
  
  
  
  A total of 137 consecutive patients with BAV stenosis (93 males, 44 females; mean age 61 ± 9 years) underwent aortic valve replacement with or without concomitant aortic surgery between January 2012 and March 2015. All patients underwent preoperative cardiac magnetic resonance imaging (cMRI) in order to evaluate morphological/functional parameters of the aortic root. Fusion of the right-left coronary cusps was identified in 99 patients (72%) (R/L group), while the remaining 38 patients (28%) had right-noncoronary cusp fusion (R/N group). cMRI data were used to guide sampling of the proximal aorta during surgery. The expression/severity of aortopathy was quantified by means of proximal aortic phenotype, indexed aortic diameter, and a histological sum-score.
  
  
  
  There were no significant differences in proximal aortic diameter between the R/L and R/N groups. Moreover, there was no significant difference in the prevalence of distinct aortic phenotypes between the study subgroups. The histological sumscore was comparable between the R/L and R/N groups (2.9 ± 1.5 versus 2.5 ± 1.1, p = 0.2). The angle LV/aorta was significantly larger in the R/L group than in the R/N group (52.1 ± 10.6° versus 45.1 ± 8.5°, p = 0.001). Logistic regression analysis demonstrated the angle LV/aorta and the angle jet/aorta to be predictive of a mid-ascending phenotype. The cusp fusion pattern had no significant impact on the occurrence of aortic phenotype.
  
  
  
  The study results demonstrated that cusp fusion morphotype has no significant impact on the expression and severity of bicuspid aortopathy in patients undergoing surgery for BAV stenosis.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany. Electronic correspondence: e.girdauskas@uke.de.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Girdauskas
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Germany.
authors.forename: Mina
authors.initials: M
authors.lastname: Rouman
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Germany.
authors.forename: Kushtrim
authors.initials: K
authors.lastname: Disha
authors.affiliation: Department of Radiology, Central Hospital Bad Berka, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Dubslaff
authors.affiliation: Department of Radiology, Central Hospital Bad Berka, Germany.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Fey
authors.affiliation: Institute of Pathology, Friedrich-Schiller University Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Theis
authors.affiliation: Institute of Pathology, Friedrich-Schiller University Jena, Germany.
authors.forename: Iver
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Columbia University Medical Center, New York, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.affiliation: Department of Cardiac Surgery, Central Hospital Bad Berka, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index