From the Guidelines
The prognosis after surgery for a bicuspid aortic valve with aneurysm is generally good, with most patients experiencing improved quality of life and normal life expectancy, and long-term survival rates are approximately 85-90% at 10 years post-surgery, as reported in the 2020 ACC/AHA guideline for the management of patients with valvular heart disease 1.
Key Factors Affecting Prognosis
- Age at surgery
- Overall health status
- Type of valve used (mechanical valves are more durable but require anticoagulation, while bioprosthetic valves may deteriorate over 10-15 years)
- Whether the aortic root was also repaired ### Post-Surgery Care
- Lifelong monitoring with regular echocardiograms (typically annually) and follow-up with a cardiologist
- Medications such as beta-blockers (like metoprolol 25-100mg twice daily) to control blood pressure
- Anticoagulation therapy with warfarin (target INR 2.0-3.0) for patients with mechanical valves
- Antibiotic prophylaxis may be recommended before dental procedures for the first six months after valve replacement ### Complications Affecting Long-Term Outcomes
- Valve deterioration
- Infection
- Bleeding (with anticoagulation)
- Rarely, aortic dissection in untreated segments According to the 2020 ACC/AHA guideline, surgery is recommended in patients with a BAV with or without symptoms and with a diameter of the aortic sinuses or the ascending aorta of ≥5.5 cm 1. Additionally, the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease report that in patients undergoing elective root-sparing procedures or bicuspid valve procedures, the 5- and 10-year survival rates are considerably improved—better than 80% to 90% 10-year survival rates can be expected 2.
From the Research
Prognosis After Aortic Valve Surgery for Bicuspid Aneurysm
- The prognosis after aortic valve surgery for bicuspid aneurysm is generally favorable, with studies indicating low morbidity and mortality rates 3, 4, 5.
- A study published in 2014 found that the overall 30-day mortality rate was 0.9% for patients undergoing aortic valve replacement (AVR) or AVR with aortic replacement (AVR/AN) for bicuspid aortic valve disease 3.
- Another study from 2014 reported that the 15-year freedom from adverse aortic events was 93% for patients with bicuspid aortic valve stenosis and 82% for those with tricuspid aortic valve stenosis after isolated aortic valve replacement 4.
- The presence of a bicuspid aortic valve does not appear to impact outcome after surgery for acute type A aortic dissection, with similar survival rates observed for patients with bicuspid and tricuspid aortic valves 5.
Factors Influencing Prognosis
- The size of the aortic aneurysm is an important factor in determining the prognosis after aortic valve surgery for bicuspid aneurysm 6, 7.
- Patients with larger aortic aneurysms (≥50 mm) may be at higher risk of respiratory complications and other adverse events after surgery 3.
- The presence of other risk factors, such as aortic regurgitation or organ malperfusion, may also influence the prognosis after surgery for bicuspid aneurysm 5.
Surgical Management
- The surgical management of the aorta in patients with bicuspid aortic valve disease involves prophylactic surgical aortic repair or replacement, with the goal of preventing aortic catastrophes such as rupture or dissection 7.
- The choice of surgical technique depends on the involvement and nature of the aortic valve disease, as well as the extent of aortic aneurysm formation 7.
- Root replacement is more frequently performed in patients with bicuspid aortic valve disease compared to those with tricuspid aortic valve disease 5.