Affiliation:
1. Centro Cardiologico Monzino IRCCS, Milan, Italy
2. Dipartimento di Medicina e Chirurgia, University of Milan, Italy
3. Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
4. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
5. Department of Biomedical Sciences for Health, University of Milan, Italy
6. Unità Operativa di Cardiochirurgia e Ricerca Traslazionale, San Donato IRCCS, San Donato Milanese, Italy
Abstract
Background
Literature studies suggested a lower prevalence of coronary artery disease (
CAD
) in bicuspid aortic valve (
BAV
) than in tricuspid aortic valve (
TAV
) patients. However, this finding has been challenged. We performed a meta‐analysis to assess whether aortic valve morphology has a different association with
CAD
, concomitant coronary artery bypass grafting (
CABG
), and postoperative mortality.
Methods and Results
Detailed search was conducted according to the
PRISMA
(Preferred Reporting Items for Systematic reviews and Meta‐Analyses) guideline to identify all patients with
BAV
or
TAV
and presence of
CAD
, concomitant myocardial surgical revascularization, and the postoperative mortality. Thirty‐one studies on 3017
BAV
and 4586
TAV
patients undergoing aortic valve surgery were included.
BAV
patients showed a lower prevalence of
CAD
(odds ratio [
OR
]: 0.33; 95%
CI
: 0.17, 0.65), concomitant
CABG
(
OR
, 0.45; 95%
CI
: 0.35, 0.59), and postoperative mortality (
OR
, 0.62; 95%
CI
: 0.40, 0.97) than
TAV
. However,
BAV
subjects were significantly younger than
TAV
(mean difference: −7.29; 95%
CI
: −11.17, −3.41) were more frequently males (
OR
, 1.61; 95%
CI
: 1.33, 1.94) and exhibited a lower prevalence of hypertension (
OR
, 0.58; 95%
CI
: 0.39, 0.87) and diabetes (
OR
, 0.71; 95%
CI
: 0.54, 0.93). Interestingly, a metaregression analysis showed that younger age and lower prevalence of diabetes were associated with lower prevalence of
CAD
(
Z
value: −3.03;
P
=0.002 and
Z
value: −3.10;
P
=0.002, respectively) and
CABG
(
Z
value: −2.69;
P
=0.007 and
Z
value: −3.36;
P
=0.001, respectively) documented in
BAV
patients.
Conclusions
Analysis of raw data suggested an association of aortic valve morphology with prevalence of
CAD
, concomitant
CABG
, and postoperative mortality. Interestingly, the differences in age and diabetes have a profound impact on prevalence of
CAD
between
BAV
and
TAV
. In conclusion, our meta‐analysis suggests that the presence of
CAD
is independent of aortic valve morphology.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
11 articles.
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