Kong WKF, et al. - Two large cohorts of European and Asian patients with bicuspid aortic valve (BAV) were assessed to determine the differences in valve morphology and function and aortic root dimensions between these populations. It was for the first time demonstrated in this large multicentre registry that type 1 BAV (with fusion between right and non-coronary cusp) was more frequent in Asians with BAV and they also had larger aortic dimensions compared with Europeans. These findings have important implications for prosthesis type and size selection for transcatheter aortic valve replacement (TAVR).

Methods

• Using transthoracic echocardiography, aortic valve morphology was defined, according to the number of commissures and raphe: type 0 = no raphe and two commissures, type 1 = one raphe and two commissures, type 2 = two raphes and one commissure.
• Current recommendations-based gradation of aortic stenosis and regurgitation was performed.
• Furthermore, aortic root dimensions were manually measured on transthoracic echocardiograms at the level of the aortic annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (AA).

Results

• Data reported that out of a total of 1427 patients with BAV (45.2 ± 18.1 years, 71.9% men), 794 (55.6%) were Europeans and 633 (44.4%) were Asians.
• It was noted that the groups were comparable in age and proportion of male sex.
• Researchers observed a higher prevalence of type 1 BAV with raphe between right and non-coronary cusps in Asians than Europeans (19.7% vs. 13.6%, respectively; P < 0.001), whereas a higher prevalence of type 0 BAV (two commissures, no raphe) was obvious in the Europeans than Asians (14.5% vs. 6.8%, respectively; P < 0.001).
• Additionally, in Europeans vs. Asians, the prevalence of moderate and severe aortic regurgitation was higher (44.2% vs. 26.8%, respectively; P < 0.001) whereas there were no differences in BAV with normal function or aortic stenosis.
• Researchers also found that among Asians versus Europeans, the dimensions of the aortic annulus [mean difference 1.17 mm/m², 95% confidence interval (CI) 0.96–1.39], SOV (mean difference 1.86 mm/m², 95% CI 1.47–2.24), STJ (mean difference 0.52 mm/m², 95% CI 0.14–0.90) and AA (mean difference 1.05 mm/m², 95% CI 0.57–1.52) were significantly larger after adjusting for demographics, comorbidities, and valve function.