Sex differences and survival in adults with bicuspid aortic valves: Verification in 3 contemporary echocardiographic cohorts

Background-sex-related differences in morbidity and survival in bicuspid aortic valve (bav) adults are fundamentally unknown. contemporary studies portend excellent survival for bav patients identified at early echocardiographic-clinical stages. whether bav adults incur a survival disadvantage throughout subsequent echocardiographic-clinical stages remains undetermined. methods and results-analysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of bav identified retrospectively: (1) a community cohort of 416 patients with first bav diagnosis (age 35±21 years,follow-up 16±7 years),(2) a tertiary clinical referral cohort of 2824 bav adults (age 51±16 years,follow-up 9±6 years),and (3) a surgical referral cohort of 2242 bav adults referred for aortic valve replacement (avr) (age 62±14 years,follow-up 6±5 years). for the community cohort,20-year risks of aortic regurgitation (ar),avr,and infective endocarditis were higher in men (all p=0.04); for a total bav-related morbidity risk of 52±4% vs 35±6% in women (p=0.01). the cohort's 25-year survival was identical to that in the general population (p=0.98). ar independently predicted mortality in women (p=0.001). baseline ar was more common in men (p=0.02) in the tertiary cohort,with 20-year survival lower than that in the general population (p<0.0001); age-adjusted relative death risk was 1.16 (95% confidence interval [ci] 1.05-1.29) for men versus 1.67 (95% ci 1.38-2.03) for women (p=0.001). ar independently predicted mortality in women (p=0.01). baseline ar and infective endocarditis were higher in men (both =0.001) for the surgical referral cohort,with 15-year survival lower than that in the general population (p<0.0001); age-adjusted relative death risk was 1.34 (95% ci 1.22-1.47) for men versus 1.63 (95% ci 1.40-1.89) for women (p=0.026). ar and nyha class independently predicted mortality in women (both p≤0.04). conclusions-within evolving echocardiographic-clinical stages,the long-term survival of adults with bav is not benign,as both men and women incur excess mortality. although bav-related morbidity is higher in men in the community,and ar and infective endocarditis are more prevalent in men,women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts,which is independently associated with ar. © 2016 the authors.