Abstract
Background/Aim: In patients with bicuspid aortic valves,
guidelines call for regular follow-up to monitor disease progression and
guide timely intervention. We aimed to evaluate how closely these
recommendations are followed at a tertiary care center.
Methods: This was retrospective cohort study at a tertiary care
center. Among 48,504 patients who received echocardiograms between
2013-2018, 245 patients were identified to have bicuspid aortic valve.
Bivariate analyses compared patient and echocardiographic
characteristics between patients who did and did not receive follow-up
by a cardiovascular specialist.
Results: The mean age of the cohort was 55.2 ± 15.6 years and
30.2% were female. During a median follow-up of 3.5 ± 2.2 years, 72.7%
of patients had at least one visit with a cardiovascular specialist
after diagnosis of bicuspid aortic valve by echocardiogram. Patients
followed by specialists had a higher proportion of follow-up
surveillance by echocardiogram (78.7% vs. 34.3%, p< .0001),
or by CT or MRI (41.0% vs. 3.0%, p < .0001), and were more
likely to undergo valve or aortic surgery compared with patients not
followed by specialists. Patients with moderate to severe valvular or
aortic pathology (aortic stenosis/regurgitation, dilated ascending
aorta) were not more likely to be followed by a cardiovascular
specialist or receive follow-up echocardiograms.
Conclusions: Follow-up care for patients with bicuspid aortic
valve was highly variable, and surveillance imaging was performed
sparsely despite guidelines. There is an urgent need for surveillance
and clinical follow-up mechanisms to monitor this patient population
with increased risk of progressive valvulopathy and aortopathy.