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Growth rate of ascending aorta and risk of aortic dissection in patients with bicuspid and tricuspid aortic valves undergoing intervention: systematic review and meta-analysis
Session:
Prémio Jovem Investigador
Speaker:
João Fernandes Pedro
Congress:
CPC 2026
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
22. Aortic Disease
Subtheme:
22.2 Aortic Disease – Epidemiology, Prognosis, Outcome
Session Type:
Sessão de Prémios
FP Number:
---
Authors:
João Fernandes Pedro; Ana Rita Figueiredo; Fausto J. Pinto; Daniel Caldeira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Background</span></span></strong><br /> <span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Bicuspid aortic valve (BAV) is associated with premature valve dysfunction and progressive aortic dilation, potentially leading to dissection. The evolution of aortic dimensions after valve replacement remains uncertain, particularly compared with tricuspid aortic valve (TAV) disease. This systematic review and meta-analysis aimed to compare postoperative aortic growth and the risk of major aortic events between BAV and TAV patients.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Methods</span></span></strong><br /> <span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">A systematic search of MEDLINE, CENTRAL, and Web of Science (from inception to April 2025) identified prospective and retrospective cohort studies including adult patients with BAV or TAV undergoing surgical (SAVR) or transcatheter (TAVI) aortic valve replacement. Studies were required to report longitudinal data on aortic growth rate (mm/year) or the incidence of aortic dissection or reintervention; those with concomitant aortic surgery were excluded. Data extraction and quality assessment (ROBINS-E tool) were performed using a predefined protocol. Random-effects meta-analyses estimated mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Results</span></span></strong><br /> <span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Fifteen studies were included (n = 1,772 for aortic growth; n = 2,307 for aortic dissection; n=2,598 for aortic reintervention). There was no significant difference in annual aortic growth between BAV and TAV (MD 0.15 mm/year; 95</span></span><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">% CI −0.03 to 0.33; p = 0.09; I² = 82.6%). Meta-regression confirmed that age differences between BAV and TAV cohorts did not modify the overall neutral effect on aortic growth rate.</span></span> <span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Subgroup analyses showed similar findings across study designs and procedure types (SAVR MD 0.19 mm/year; TAVI MD −0.04 mm/year). No significant differences were found in the risk of aortic dissection (RR 1.34; 95% CI 0.63–2.83; p = 0.44) or aortic reintervention (RR 0.95; 95% CI 0.56–1.61; p = 0.84). The overall risk of bias was moderate, mainly due to confounding and heterogeneity in imaging assessment.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Conclusions</span></span></strong><br /> <span style="font-size:10.0pt"><span style="font-family:"Aptos",sans-serif">Postoperative aortic growth and event rates were comparable between BAV and TAV patients after valve replacement. These results challenge the long-standing assumption that bicuspid morphology intrinsically accelerates postoperative aortopathy, suggesting that aortopathic pathophysiology after valve replacement may be driven more by patient-specific factors than by leaflet phenotype. Also, it emphasizes the importance of individualized treatment approaches and surveillance strategies after valve replacement.</span></span></span></span></p>
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