Valvular & structural heart disease
Early predictors of aortic valve surgery in patients with significant bicuspid aortic regurgitation without initial surgical indication
Authors' conclusion
In patients with significant bicuspid AR who do not initially meet indications for AV surgery, increased LV mass index, impaired LA reservoir strain and concomitant moderate AS are early predictors of surgical progression. These parameters may enhance surveillance strategies and inform earlier surgical referral in selected patients.
Study context
- Population
- Patients with bicuspid aortic valve (AV) and moderate or severe aortic regurgitation (AR) who did not initially meet the surgical criteria, excluding those with severe aortic stenosis (AS), endocarditis or other major valvular diseasesincluded in the final analysis (mean age 52±14.0 years, 80% male), of 335 patients with moderate or severe AR from a registry of 1927 patients with bicuspid AV
- Participants
- 199 patients
- Outcome
- Progression to AV surgery
- Follow-up
- Mean 4.9 years
Methodological detailsmultivariable Cox regression, speckle-tracking-derived strain measurements
- Multivariable Cox regression
- Speckle-tracking-derived strain measurements
Main finding
As reported in the abstract
Hazard ratio (95% CI)P value
LV mass index ≥113 g/m²
4.49(1.74–11.6)
P = 0.002LA reservoir strain <28%
3.07(1.40–6.74)
P = 0.005Concomitant moderate AS
3.19(1.40–7.28)
P = 0.006- Patients who underwent AV surgery, primarily for symptom onset or left ventricular (LV) enlargement
- 41 patients (21%)
Observational data: associations, not effects.
Original publication
Early predictors of aortic valve surgery in patients with significant bicuspid aortic regurgitation without initial surgical indication. Heart. Published 20 June 2025. doi:10.
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