Bicuspid aortic valve morphology and its association with aortic dilatation: a meta-analysis
Session
Medicine and Nursing
Description
Background - Aortopathy in patients with bicuspid aortic valve (BAV) is increasingly recognized to be a heterogeneous disease entity. Likewise, many studies suggest that the bicuspid valve morphology influences aortic dilatation, but the association of the two is yet to be understood. We therefore, compared, in a meta-analysis, the effect of right-left coronary cusp fusion (RL) and right-non coronary cusp fusion (RN) on the pattern of aortic dilatation.
Methods – Up to November 2017, a systematic search of electronic databases was conducted to identify all studies that compared aortic dimensions in patients with BAV. Raw mean differences in millimeters was analyzed using Comprehensive Meta Analysis software, and data was combined using random-effect model.
Results - Twenty studies reported aortic dimensions for 3854 patients with RL and 1735 patients with RN BAV (with or without raphe). Indexed and non-indexed values were compared at the level of aortic annulus, sinuses of Valsalva, sinotubular junction and ascending aorta. Using indexed values showed only the sinuses of the Valsalva wider in RL BAV patients (mean difference 1.84 (95% CI: 0.46–3.23), p < 0.009, I2 = 90.4%). Using non-indexed values showed the annulus (mean difference 1.38 (95% CI: 0.62–2.13), p < 0.000, I2 = 84%), sinuses of Valsalva (mean difference 2.94 (95% CI: 1.75–4.12), p < 0.000, I2 = 88.2%), and sinotubular junction (mean difference 1.28 (95% CI: 0.27–2.29), p < 0.013, I2 = 76.8%) wider in RL BAV patients but similar ascending aorta diameter (mean difference 0.14 (95% CI: -1.16–1.44), p < 0.83, I2 = 87.4%).
Conclusions – The meta-analysis found wider aortic diameters in RL BAV compared to RN BAV patients. This might suggest a contributing effect of the transvalvular flow direction and its relationship with the aortic wall. However, it does not necessarily exclude differences of development style and tissue composition. Thus, categorizing BAV subtypes may serve as a clinical tool for optimum follow-up strategies in order to provide optimum evidence based management.
Keywords:
bicuspid aortic, valve aortic, dilatation aortopathy
Session Chair
Fitim Alidema
Session Co-Chair
Salih Krasniqi
Proceedings Editor
Edmond Hajrizi
ISBN
978-9951-550-19-2
Location
Pristina, Kosovo
Start Date
26-10-2019 1:30 PM
End Date
26-10-2019 3:00 PM
DOI
10.33107/ubt-ic.2019.301
Recommended Citation
Jashari, Haki, "Bicuspid aortic valve morphology and its association with aortic dilatation: a meta-analysis" (2019). UBT International Conference. 301.
https://knowledgecenter.ubt-uni.net/conference/2019/events/301
Bicuspid aortic valve morphology and its association with aortic dilatation: a meta-analysis
Pristina, Kosovo
Background - Aortopathy in patients with bicuspid aortic valve (BAV) is increasingly recognized to be a heterogeneous disease entity. Likewise, many studies suggest that the bicuspid valve morphology influences aortic dilatation, but the association of the two is yet to be understood. We therefore, compared, in a meta-analysis, the effect of right-left coronary cusp fusion (RL) and right-non coronary cusp fusion (RN) on the pattern of aortic dilatation.
Methods – Up to November 2017, a systematic search of electronic databases was conducted to identify all studies that compared aortic dimensions in patients with BAV. Raw mean differences in millimeters was analyzed using Comprehensive Meta Analysis software, and data was combined using random-effect model.
Results - Twenty studies reported aortic dimensions for 3854 patients with RL and 1735 patients with RN BAV (with or without raphe). Indexed and non-indexed values were compared at the level of aortic annulus, sinuses of Valsalva, sinotubular junction and ascending aorta. Using indexed values showed only the sinuses of the Valsalva wider in RL BAV patients (mean difference 1.84 (95% CI: 0.46–3.23), p < 0.009, I2 = 90.4%). Using non-indexed values showed the annulus (mean difference 1.38 (95% CI: 0.62–2.13), p < 0.000, I2 = 84%), sinuses of Valsalva (mean difference 2.94 (95% CI: 1.75–4.12), p < 0.000, I2 = 88.2%), and sinotubular junction (mean difference 1.28 (95% CI: 0.27–2.29), p < 0.013, I2 = 76.8%) wider in RL BAV patients but similar ascending aorta diameter (mean difference 0.14 (95% CI: -1.16–1.44), p < 0.83, I2 = 87.4%).
Conclusions – The meta-analysis found wider aortic diameters in RL BAV compared to RN BAV patients. This might suggest a contributing effect of the transvalvular flow direction and its relationship with the aortic wall. However, it does not necessarily exclude differences of development style and tissue composition. Thus, categorizing BAV subtypes may serve as a clinical tool for optimum follow-up strategies in order to provide optimum evidence based management.