Long term durability of bioprosthetic aortic valve replacement in young patients with bicuspid aortic stenosis

Objective To examine long-term surgical aortic valve replacement (SAVR) outcomes for young (<65 years) bicuspid aortic valve (BAV) aortic stenosis (AS) patients with or without concomitant aneurysm. Background There are few studies evaluating the early and late outcomes of SAVR in young patients (<65 years) with BAV and aortic stenosis. Methods Using institutional data from 2004-2022, 498 BAV patients less than 65 underwent SAVR for AS with bioprosthetic valves. We examined operative outcomes, long term valve durability and reintervention. Results The total cohort comprised of 281 isolated SAVR patients and 217 with concomitant aneurysm repair (SAVR/AN). The average age was 55 ± 8 years, with STS PROM: 0.8 (0.5, 1.0) and mean valve size: 25mm. Operative mortality (0.7% vs. 1.4%, p=0.77) was similar between SAVR and SAVR/AN patients. Predischarge permanent pacemaker implantation occurred in 1.6% (n=8/498) patients. During follow-up of 5.0 (2.0, 9.6; range: 0.2, 18.2 years), the cumulative incidence of reintervention at 10 years for structural valve degeneration (n=33) including Valve-in-Valve (ViV; n=15) was 6.6% (8.1% SAVR vs. 4.5% SAVR/AN, p=0.66). No mortality was observed for ViV or redo-SAVR. Moderate or greater aortic regurgitation and paravalvular leak were observed in 6.5% and 0.3% respectively at most recent follow-up. Conclusion Bicuspid aortic stenosis is common in <65-year-olds and management includes consideration of future valve intervention. SAVR confers excellent operative and re-operative outcomes, 10-year durability and valve function. These results may support initial SAVR when considering lifetime management of aortic stenosis.