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espanolIntroduccion: La valvula aortica bicuspide (VAB) es una cardiopatia congenita que puede asociarse a complicaciones aorticas y/o valvulares. Resulta importante identificar los grupos de riesgo para realizar un estrecho seguimiento e indicar la intervencion a tiempo. Este trabajo propone analizar el impacto que tienen las caracteristicas clinicas y morfologicas valvulares en el desarrollo de la disfuncion valvular aortica moderada/grave (significativa) y en la incidencia de eventos cardiovasculares mayores en adultos con VAB. Material y metodos: Se seleccionaron pacientes consecutivos con diagnostico de VAB no sindromatica (2010-2019) en seguimiento en el ICSI. Se recabo informacion clinica y ecocardiografica de manera prospectiva. Se realizo analisis uni y multivariado para identificar las caracteristicas clinicas y morfologicas predictoras de disfuncion valvular significativa y de eventos cardiovasculares mayores (muerte, cirugia, sindrome aortico). Una p menor a 0,05 fue considerada significativa. Resultados: Se siguieron 300 pacientes (44.3 ± 15.3 anos, 71% varones). La mayoria con VAB tipo I y con presencia de rafe (79,6% y 77%, respectivamente). La edad media de diagnostico fue de 36.3 ±16.2 anos. Hubo 84 pacientes (31,2%) que presentaban disfuncion valvular aortica significativa al momento del inicio del estudio. Con un seguimiento de 4.9 ± 1.7 anos, 23 pacientes requirieron cirugia cardiaca (7,7%) y 3 fallecieron (1%). Al final del seguimiento 101 pacientes (33,6%) presentaban disfuncion valvular aortica significativa. La presencia de al menos uno de los siguientes factores: prolapso valvular, calcificacion valvular aortica basal > 1 y edad > 50 anos, se asocio a menor sobrevida libre de disfuncion valvular aortica significativa y de eventos mayores. Conclusiones: En nuestra cohorte, observamos una alta incidencia de eventos asociados a VAB. Dentro de las variables analizadas, la presencia de al menos un factor de riesgo se asocio a menor sobrevida libre de eventos mayores y disfuncion significativa a 4.9 anos. EnglishBackground: Bicuspid aortic valve (BAV) is a congenital heart disease that can be associated with aortic and/or valve complications. It is important to identify risk groups for a closer follow up and timely intervention. Objective: The aim of this work is to analyze the impact of clinical and morphological valve characteristics in the development of moderate/severe (significant) aortic valve dysfunction and in the incidence of major cardiovascular events in adults with BAV. Methods: Consecutive patients with diagnosis of non-syndromic BAV (2010-2019) followed up at our institution were incorporated in the study. Clinical and echocardiographic information was prospectively collected. Univariate and multivariate analyses were performed to identify clinical and morphological characteristics that predict significant valve dysfunction and major cardiovascular events (death/surgery/aortic syndrome). A p value Results: Three-hundred patients (44.3 ± 15.3 years, 71% men), the majority with type I BAV and presence of raphe (79.6% and 77%, respectively) were included. Mean age at diagnosis was 36.3±16.2 years, and 84 patients (31.2%) presented significant aortic valve dysfunction at the onset of the study. Twenty-three patients required cardiac surgery (7.7%) and 3 died (1%) during a follow-up of 4.9±1.7 years. At the end of the followup period, 101 (33.6%) patients had significant aortic valve dysfunction. The presence of at least 1 of the following factors: valve prolapse, baseline aortic valve calcification >1 and age >50 years were associated with lower significant aortic valve dysfunction and major cardiovascular event-free survival. Conclusions: In our cohort, we observed a high incidence of events associated with BAV. Among the variables analyzed, the presence of at least 1 risk factor was associated with lower event-free survival and significant dysfunction at 4.9 years. |
