Comparative study of bicuspid vs. tricuspid aortic valve stenosis

Geoffrey D. Huntley, Jeremy J. Thaden, Said Alsidawi, Hector I. Michelena, Joseph J. Maleszewski, William D. Edwards, Christopher G. Scott, Sorin V. Pislaru, Patricia A. Pellikka, Kevin L. Greason, Naser M. Ammash, Joseph F. Malouf, Maurice Enriquez-Sarano, Vuyisile T. Nkomo

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Aims To examine differences and similarities in bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) stenosis occurring during the same age and whether any differences impact outcomes following aortic valve replacement (AVR). Methods and results An age-matched cohort of 198 BAV stenosis and 198 TAV stenosis patients was identified from 888 consecutive patients undergoing AVR for severe AS. Mean age 68 ± 6 years; 68% male. Patients with BAV were less likely to have multiple comorbidities, as measured by the Charlson Comorbidity Index (CCI) >2 (3 vs. 10%, P = 0.007). Indexed aortic valve area (0.44 ± 0.09 vs. 0.42 ± 0.08 cm 2 /m 2, P = 0.17) and left ventricular ejection fraction (LVEF) were similar (62 ± 11 vs. 61 ± 12%, P = 0.12), but E/e' ≥15 (46 vs. 66%, P = 0.0002) was less common in BAV stenosis. A tissue aortic valve prosthesis was more commonly utilized in both groups (81 vs. 78%, P = 0.54). Overall indexed effective orifice area was larger in BAV compared with TAV (1.08 ± 0.33 vs. 0.96 ± 0.25 cm 2 /m 2, P = 0.0008). Five-year survival following AVR was lower in TAV compared with BAV stenosis (61 vs. 79%, P = 0.02). Independent predictors of survival following AVR were LVEF < 50% [hazard ratio (HR): 4.8, P = 0.0005], CCI > 2 (HR: 3.1, P = 0.015), effective orifice area index ≤0.85 cm 2 /m 2 (HR: 2.5, P = 0.004), and bioprosthesis (HR: 3.7, P = 0.02). Conclusion In an age-matched cohort, TAV compared with BAV stenosis is associated with greater prevalence of cardiovascular risk factors and cardiac impairment and worse survival after AVR. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)3-8
Number of pages6
JournalEuropean heart journal cardiovascular Imaging
Issue number1
StatePublished - Jan 1 2018


  • aortic stenosis
  • aortic valve replacement
  • bicuspid aortic valve
  • comorbidities

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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