PMID- 31543305 OWN - NLM STAT- MEDLINE DCOM- 20200622 LR - 20210110 IS - 1097-685X (Electronic) IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 159 IP - 6 DP - 2020 Jun TI - Surgical repair of bicuspid aortopathy at small diameters: Clinical and institutional factors. PG - 2216-2226.e2 LID - S0022-5223(19)31583-1 [pii] LID - 10.1016/j.jtcvs.2019.06.103 [doi] AB - OBJECTIVE: Bicuspid aortic valve is a common risk factor for thoracic aortic aneurysm and dissection. Guidelines for elective ascending aortic intervention (AAI) in bicuspid aortic valve are derived from limited evidence, and the extent of practice variation due to patient and provider characteristics is unknown. Using data from 2 large cardiovascular registries, we investigated factors that influence decisions for AAI. METHODS: All bicuspid aortic valve cases with known aortic diameters and surgical status were included. We used multivariable logistic regression to profile predictors of isolated aortic valve replacement (AVR) or AVR+AAI, stratified by patient characteristics, surgical indications, and institution. RESULTS: We studied 2861 subjects at 18 institutions from 1996 to 2015. The median aortic diameter of patients who underwent AVR+AAI varied widely across institutions (39-52 mm). Aortic diameters were <45 mm in 38% of patients undergoing AVR+AAI. Patients who underwent AAI at <45 mm, compared with those managed nonoperatively, were younger (54 +/- 13 vs 61 +/- 15 years; P < .001) with more frequent aortic stenosis (53% vs 28%; P < .001) and regurgitation (52% vs 18%; P < .001). CONCLUSIONS: Clinical and institutional factors influence the timing of AAI and are associated with significant variability in ascending aortic diameter at AAI across institutions. More than one third of patients with a bicuspid aortic valve undergo AAI at aortic diameters <45 mm. Long-term outcomes of this subgroup of patients, who may manifest earlier and more severe disease, are needed to determine the risk-benefit ratio of routine aortic interventions at smaller diameters. CI - Copyright (c) 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. FAU - Nissen, Alexander P AU - Nissen AP AD - Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, Houston, Tex; Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex. FAU - Truong, Van Thi Thanh AU - Truong VTT AD - Center for Clinical Research & Evidence-Based Medicine, The University of Texas Health Science Center at Houston, Houston, Tex. FAU - Alhafez, Bader A AU - Alhafez BA AD - Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio. FAU - Puthumana, Jyothy J AU - Puthumana JJ AD - Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill. FAU - Estrera, Anthony L AU - Estrera AL AD - Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, Houston, Tex. FAU - Body, Simon C AU - Body SC AD - Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. FAU - Prakash, Siddharth K AU - Prakash SK AD - Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Tex. Electronic address: Siddharth.K.Prakash@uth.tmc.edu. CN - BAVCon Investigators CN - GenTAC Registry Investigators LA - eng GR - HHSN268201000048C/HL/NHLBI NIH HHS/United States GR - R01 HL114823/HL/NHLBI NIH HHS/United States GR - R01 HL137028/HL/NHLBI NIH HHS/United States GR - UL1 TR003167/TR/NCATS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Webcast DEP - 20190822 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CIN - J Thorac Cardiovasc Surg. 2020 Jun;159(6):2227. PMID: 31400818 CIN - J Thorac Cardiovasc Surg. 2020 Jun;159(6):2228-2229. PMID: 31629498 MH - Adult MH - Aged MH - Aortic Aneurysm, Thoracic/diagnostic imaging/etiology/*surgery MH - Aortic Valve/*abnormalities/diagnostic imaging/surgery MH - Aortic Valve Insufficiency/diagnostic imaging/etiology/*surgery MH - Aortic Valve Stenosis/diagnostic imaging/etiology/*surgery MH - Bicuspid Aortic Valve Disease MH - Clinical Decision-Making MH - Cross-Sectional Studies MH - Elective Surgical Procedures MH - Female MH - Heart Valve Diseases/complications/diagnostic imaging/*surgery MH - *Heart Valve Prosthesis Implantation/adverse effects MH - Humans MH - Male MH - Middle Aged MH - Patient Selection MH - Registries MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - United States MH - *Vascular Surgical Procedures/adverse effects PMC - PMC7035185 MID - NIHMS1063561 OTO - NOTNLM OT - ascending aortic intervention OT - bicuspid aortic valve OT - thoracic aortic aneurysm OT - thoracic aortic dissection COIS- Conflict of Interest Statement Dr Estrera has received support as a consultant from W.L. Gore & Associates. All other authors have nothing to disclose with regard to commercial support. FIR - Bossone, Eduardo IR - Bossone E FIR - Citro, Rodolfo IR - Citro R FIR - Body, Simon IR - Body S FIR - Muehlschlegel, J Daniel IR - Muehlschlegel JD FIR - Shahram, Jasmine T IR - Shahram JT FIR - Nguyen, Thy B IR - Nguyen TB FIR - Stefano Nistri, Vicenza IR - Stefano Nistri V FIR - Gilon, Dan IR - Gilon D FIR - Durst, Ronen IR - Durst R FIR - de Vincentiis, Carlo IR - de Vincentiis C FIR - Pluchinotta, Francesca R IR - Pluchinotta FR FIR - Sundt, Thoralf M IR - Sundt TM FIR - Michelena, Hector I IR - Michelena HI FIR - Limongelli, Giuseppe IR - Limongelli G FIR - McCarthy, Patrick M IR - McCarthy PM FIR - Malaisrie, S Chris IR - Malaisrie SC FIR - Bavishi, Aakash IR - Bavishi A FIR - Bissell, Malenka M IR - Bissell MM FIR - Huggins, Gordon S IR - Huggins GS FIR - Dayan, Victor IR - Dayan V FIR - Dagenais, Francois IR - Dagenais F FIR - Corte, Alessandro Della IR - Corte AD FIR - Girdsaukas, Evaldas IR - Girdsaukas E FIR - Yang, Bo IR - Yang B FIR - Eagle, Kim IR - Eagle K FIR - Prakash, Siddharth K IR - Prakash SK FIR - Milewicz, Dianna M IR - Milewicz DM FIR - Nguyen, Tom C IR - Nguyen TC FIR - Sandhu, Harleen K IR - Sandhu HK FIR - Safi, Hazim J IR - Safi HJ FIR - Denny, Josh C IR - Denny JC FIR - Evangelista, Arturo IR - Evangelista A FIR - Galian-Gay, Laura IR - Galian-Gay L FIR - Eagle, Kim A IR - Eagle KA FIR - Ravekes, Williams IR - Ravekes W FIR - Dietz, Harry C IR - Dietz HC FIR - Holmes, Kathryn W IR - Holmes KW FIR - Habashi, Jennifer IR - Habashi J FIR - Milewicz, Dianna M IR - Milewicz DM FIR - Prakash, Siddharth K IR - Prakash SK FIR - LeMaire, Scott A IR - LeMaire SA FIR - Coselli, Joseph S IR - Coselli JS FIR - Morris, Shaine A IR - Morris SA FIR - Maslen, Cheryl L IR - Maslen CL FIR - Song, Howard K IR - Song HK FIR - Silberbach, G Michael IR - Silberbach GM FIR - Pyeritz, Reed E IR - Pyeritz RE FIR - Bavaria, Joseph E IR - Bavaria JE FIR - Milewski, Karianna IR - Milewski K FIR - Devereux, Richard B IR - Devereux RB FIR - Weinsaft, Jonathan W IR - Weinsaft JW FIR - Roman, Mary J IR - Roman MJ FIR - Shohet, Ralph V IR - Shohet RV FIR - McDonnell, Nazli IR - McDonnell N FIR - Asch, Federico M IR - Asch FM FIR - Tolunay, H Eser IR - Tolunay HE FIR - Desvigne-Nickens, Patrice IR - Desvigne-Nickens P FIR - Tseng, Hung IR - Tseng H FIR - Kroner, Barbara L IR - Kroner BL EDAT- 2019/09/24 06:00 MHDA- 2020/06/23 06:00 PMCR- 2020/12/01 CRDT- 2019/09/24 06:00 PHST- 2019/01/15 00:00 [received] PHST- 2019/06/03 00:00 [revised] PHST- 2019/06/09 00:00 [accepted] PHST- 2019/09/24 06:00 [pubmed] PHST- 2020/06/23 06:00 [medline] PHST- 2019/09/24 06:00 [entrez] PHST- 2020/12/01 00:00 [pmc-release] AID - S0022-5223(19)31583-1 [pii] AID - 10.1016/j.jtcvs.2019.06.103 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2020 Jun;159(6):2216-2226.e2. doi: 10.1016/j.jtcvs.2019.06.103. Epub 2019 Aug 22.