Demographic Characteristics, BAV Sievers Types, and Interactions Between BAV-Associated Valvulopathy and Aortopathy Differently Affect BAV Comorbidities and Outcomes of Aortic Valve Replacement

Background Bicuspid aortic valve (BAV) is a common congenital disorder. The relationship between demographic and clinical characteristics, BAV Sievers types, BAV associated valvulopathy and/or aortopathy and outcomes of aortic valve replacement (AVR) are interwoven and complicate and have not been fully elucidated. We sought to find these interactions in a large cohort of BAV patients. Methods We retrospectively reviewed the data of 992 BAV patients and collected the complete demographic and clinical data (baseline characteristic, BAV Sievers types, BAV valvulopathy and aortopathy, and pre-, intra- and postoperative data) to comprehensively analyze these relationships. Results In 992 BAV patients, sex differences could be found in demography (body surface area [BSA], age and serum triglyceride), comorbidities, cardiac performance (left ventricular dimension and ejection fraction,), valvulopathy and aortopathy. Sievers types had the same distribution among male and female patients, and had an impact on the incidence of valvulopathy and aortopathy. In the entire cohort, the factors associated with valvulopathy included age, sex, BSA, systolic blood pressure (SBP) and aortopathy, while factors associated with aortopathy were age, sex, BSA and valvulopathy. Aortopathy and valvulopathy promoted the occurrence of each other. Similar risk factors for valvulopathy and aortopathy in male patients were found. For 658 BAV patients underwent AVR, the preoperative demographic characteristics were similar to the whole cohort. More males were required to have simultaneous ascending aortic replacement (AAR). For postoperative early adverse events (EAE) and total ICU hours > 24 hours, the only predict factors were age and aortic cross clamp (ACC) time, while LVEF changes (including postoperative LVEF <50%, LVEF increase or decrease more or less than 5% or 10%) were related to sex, SBP, preoperative LVEF, valvulopathy and aortopathy, AAR, ACC time. Postoperative length of stay > 7 days could be affected by SBP, AAR, aortic stenosis and ACC time. Conclusion Our study revealed comprehensive relationships between demographic characteristics, BAV Sievers types, valvulopathy and aortopathy, and the possible risk factors for adverse outcomes after AVR in BAV patients. Sex, SBP, age, Sievers types, subtypes and interactions between aortopathy and valvulopathy differently impact on aortopathy, valvulopathy and the short outcomes of AVR. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ChiCTR-RRC-17013678 ### Funding Statement No external funding was received. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Beijing Anzhen Hospital, Capital Medical University All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data referred to in the manuscript are available upon request.