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Objective: The best aortic prosthesis type in 60-70 year old patients is not established. Our aim was to evaluate the survival in a National cohort of patients between 60-70 years old who required surgical aortic valve replacement for aortic stenosis (SAVR) with either a mechanical (MP) or bioprosthesis (BP) valve., Methods: This is a retrospective study using national data from the Ministry of Health. We included all patients between 60 to 70 years old who underwent SAVR for aortic stenosis in Uruguay from 2011 to 2021. The primary outcome was overall survival according to type of prosthesis used stratified by effect modifiers. The independent effects of gender and use of statins were evaluated., Results: We included 1196 patients (66±3.0 years old; 39.1% female). Mortality was higher for BP (296, 29.9%%) than MP (36, 17.1%; p<0.001). Median follow-up time was 4.5 years (Interquartile range [IQR] 3.4-6.5). The unadjusted incidence rate ratio was higher for BP (Incidence rate ratio [IRR] = 1.43;95%CI: 0.99, 2.14, p = 0.045). The effect of BP on mortality rate was greater in males (IRR = 1.82;95%CI:1.14,2.92. p interaction = 0.08) and patients who were not taking statins (IRR = 1.97;95%CI:1.14,3.41. p interaction = 0.06). The use of BP was an independent predictor of overall survival in male patients (Hazard ratio [HR] = 1.32;95%CI: 1.68, 1.04. p = 0.021) and in patients who were not taking statins (HR = 2.07;95%CI: 1.17, 3.67. p = 0.013)., Conclusion: The use of BP was associated with worse survival in male patients and patients not taking statins. Gender and statins use should contribute to type of prosthesis decision in the 60-69 age group., Competing Interests: UCL receives funding from EACTS for methodological advice and teaching. Fee for consultation for ALK, AstraZeneca and Sanofi Aventis and sit on a data monitoring committee for Orion. There are no patents, products in development or marketed products associated with this research to declare., (Copyright: © 2024 Dayan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Bicuspid aortic valve (BAV) is the most frequent cardiac congenital valvular disease. Although the BAV risk of first degree relatives (FDR) has been assessed (7-9%), there is little information as to the heritable risk for aortopathy., Objective: Identify the specific risk for regional aortopathy in FDR with tricuspid aortic valve (TAV) of BAV patients according to their aortic phenotype and aortic regurgitation (AR)., Methods: Using an international consortium, BAV probands were assessed for aortopathy of the root, ascending aorta and for AR. Aortopathy was defined by the presence of segmental dilatation. The presence of segmental aortopathy and AR in BAV probands was evaluated as predictor for aortopathy in FDR with TAV., Results: We identified 74 FDR related to 49 probands with aortopathy and 66 FDR related to 31 probands without aortopathy. Demographic variables were similar between proband groups. Among FDR, 16 individuals had BAV (11.4%). TAV-FDR of probands with ascending aortopathy had higher incidence of root aortopathy (18.8% vs. 3.6% p < 0.05) while TAV-FDR of probands with root aortopathy had higher incidence of aortopathy at all aortic segments (55%vs25%, 55%vs21%, and 4%vs29% at annulus, root and ascending respectively, p < 0.05 for all). Independent predictors for root aortopathy in TAV-FDR were: ascending (OR = 6.23;95%CI:1.27-30.5) and root aortopathy (OR = 9.00;95%CI:1.58-51.1) in probands; and for ascending aortopathy: root aortopathy (OR = 4.04;95%CI:1.33-12.3) and AR in probands (OR = 4.84; 95%CI:1.75-13.4)., Conclusion: Root and ascending aortopathy in BAV probands are strong predictors of aortopathy in their TAV-FDR. AR in BAV patients has an independent effect on the risk for ascending aortopathy in TAV-FDR., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background Bicuspid aortic valve patients have an increased risk of aortic dilatation. A deficit of nitric oxide synthase has been proposed as the causative factor. No correlation between flow-mediated dilation and aortic diameter has been performed in patients with bicuspid aortic valves and normal aortic diameters. Being a hereditary disease, we compared echocardiographic features and endothelial function in these patients and their first-degree relatives. Methods Comprehensive physical examinations, routine laboratory tests, transthoracic echocardiography, and measurements of endothelium-dependent and non-dependent flow-mediated vasodilatation were performed in 18 bicuspid aortic valve patients (14 type 1 and 4 type 2) and 19 of their first-degree relatives. Results The first-degree relatives were younger (36.7 ± 18.8 vs. 50.5 ± 13.9 years, p = 0.019) with higher ejection fractions (64.6% ± 1.7% vs. 58.4% ± 9.5%, p = 0.015). Aortic diameters indexed to body surface area were similar in both groups, the except the tubular aorta which was larger in bicuspid aortic valve patients (19.3 ± 2.7 vs. 17.4 ± 2.2 mm·m -2 , p = 0.033). Flow-dependent vasodilation was similar in both groups. A significant inverse correlation was found between non-flow-dependent vasodilation and aortic root diameter in patients with bicuspid aortic valve ( R = -0.57, p = 0.05). Conclusions Bicuspid aortic valve patients without aortopathy have larger ascending aortic diameters than their first-degree relatives. Endothelial function is similar in both groups, and there is no correlation with ascending aorta diameter. Nonetheless, an inverse correlation exists between non-endothelial-dependent dilation and aortic root diameter in bicuspid aortic valve patients.