An estimated 2% of the US population has a bicuspid aortic valve, making it the most common congenital heart defect.1

What Is BAV?

What Is BAV?

In a normal aortic valve, there are three leaflets that open and close to allow blood to flow from the heart, to the aorta, and out to the body. This normal aortic valve with three functioning leaflets prevents blood from flowing backwards into the heart. In a bicuspid aortic valve (BAV), the valve has only two leaflets which means the valve may not close and open properly.

Aortic

test)100x100

Bicuspid

test)100x100

Stenotic Bicuspid

test)100x100

A bicuspid aortic valve (BAV) typically causes aortic stenosis, which is a narrowing of the aortic valve, like when you hold your finger over a hose to increase the water pressure. This narrow valve opening leads to reduced blood flow from the heart to the body, causing various health issues. Not as commonly, a BAV can also cause aortic regurgitation which occurs when the valve does not close tightly. This causes blood to leak backwards into the ventricle of the heart.1-2 Additional defects occur in up to 50% of adults with a BAV and can include abnormal coronary arteries, aortic aneurysm, and/or an abnormal thoracic aorta.2 If you have been diagnosed with a BAV or think you may have a BAV, it is important to consult your cardiologist and/or cardiac surgeon for your best surgical option.

 

Signs and Symptoms

Signs and Symptoms

Although a BAV is present at birth, people with BAV may have a valve that functions adequately for years, with symptoms typically developing in adulthood.1-2 Whether a BAV causes aortic stenosis or aortic regurgitation, symptoms that may occur with physical effort include:

  • Shortness of breath
  • Dizziness
  • Fainting
  • Chest pain

As the disease (aortic stenosis or regurgitation) progresses, these symptoms may worsen and occur more frequently even without physical effort. That is why it is important to know the signs and symptoms and seek help if you may have a BAV.

Know Your Options

Know Your Options

Typically, people with a BAV develop symptoms in earlyadulthood. These people are generally younger and have a lot of life left to live. If you have been diagnosed with a BAV, it is important to know and understand your options, so you can live long and live well.

There are several options available today to replace your aortic valve. Every patient is unique, so it is important to understand your options and ask your cardiologist and cardiac surgeon for the option that is best for you.

Ross Procedure

  • An operation that uses the patient’s own healthy and living pulmonary valve, called a pulmonary autograft, to replace the damaged aortic valve.
  • This is the only aortic valve replacement option proven to result in life expectancy and quality of life similar to someone who has not had aortic valve surgery.3-4
  • It is important to note that this procedure should be performed by a surgeon familiar with this technique.
  • A 2015 Ross Procedure study with 92% of patients with bicuspid aortic valves resulted in 97% patient survival at 15-years after surgery, and 93% of patients needing no reintervention on either valve involved in their Ross Procedure.5

Compare your aortic valve replacement options over time.

Mechanical Valve

  • Long-lasting valves made of durable materials.
  • Most mechanical heart valves are bileaflet, meaning that they have two “leaflets” to control the blood flow to a single direction.6
  • While mechanical valves are often more durable, the risk for blood clot formation is higher, so lifelong use of blood thinner medication is necessary.
  • The On-X Aortic Valve is in a category of its own as the only mechanical valve made of pure pyrolytic carbon designed to last a patient’s lifetime and approved to be used safely with less blood thinner compared to other mechanical valves.*,7
  • This lower blood thinner requirement results in a significantly lower risk for bleeding by >60%.8
  • To learn more about the On-X Aortic Valve, visit www.heartvalvechoice.com

Compare your aortic valve replacement options over time.

* After 3 months standard therapy. See On-X Prosthetic Heart Valve Instructions for Use, https://www.onxlti.com/ifu/hv/, Accessed 12-04-2019.

Tissue Valve

  • Also called “bioprosthetic valves”, tissue valves are made with animal tissue, typically pig or cow. Some tissue valves are mounted on a frame or stent, while others are stentless.
  • While tissue valves are commonly used for aortic valve replacement, their main downside is limited durability. Over time, these valves will begin to break down, leak, or become stiff and too small again, reintroducing symptoms of valve stenosis and regurgitation with a condition called Structural Valve Deterioration (SVD).
    • Only tissue valves develop SVD and there is no known medical therapy to prevent or treat SVD.9
    • SVD causes patients to feel tired and short of breath as their new aortic tissue valve deteriorates.9-11
    • Implanted tissue valves that develop SVD may require reintervention, and the younger a patient is when they get a tissue valve, the faster they will experience the onset of SVD.7,9

Compare your aortic valve replacement options over time.

Transcatheter Aortic Valve Replacement (TAVR)

  • The majority of TAVR studies exclude bicuspid aortic patients; therefore, there is very little data on the long-term durability of TAVR in bicuspid aortic valve patients.12-13
  • Relatively new technology typically performed in elderly and/or high-risk patients to avoid the risk of surgery. Involves inserting a new tissue valve into the diseased aortic valve using a large catheter either through the femoral artery in the groin (transfemoral) or through a small incision in the chest (transapical).
  • Recent 1-year data published for the new generation of TAVR valves included low-risk patients, meaning these patients had less existing health conditions than high-risk patients.14-15
  • Low-risk does not mean younger patients. The average age of patients in the two recent TAVR studies was 73 and 74 years-old.14-15

Compare your aortic valve replacement options over time.
  1. M. Kaczmarczyk, “Minimally invasive aortic valve replacement – pros,” Kardiochirurgia i Torakochirurgia Polska, 2015.
  2. e. a. A Mazine, J Am Coll Cardiol, vol. 72, no. (22), pp. 2761-77, 2018.
  3. e. a. I El Hamamsy, Lancet, vol. 72, no. (22), pp. 524-31, 2010.
  4. e. a. T Bourguignon, Eur J Cardiothorac Surg, pp. 1462-8, 2016.
  5. e. a. K Minakata, J Card Surg, vol. 30, no. (5), pp. 405-13, 2015.
  6. e. a. T Rodriguez-Gabella, J Am Coll Cardiol, vol. 70, no. 8, pp. 1013-28, 2017.
  7. “Aortic Stenosis,” Mayo Clinic, [Online]. Available: https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139. [Accessed 25 11 2019].
  8. “Aortic Valve Regurgitation,” Mayo Clinic, [Online]. Available: https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/symptoms-causes/syc-20353129. [Accessed 25 11 2019].
  9. e. a. RA Nishimura, J Am Coll Cardiol, vol. 70, no. (2), pp. 252-89.
  10. “Aortic Valve Replacement: Minimally Invasive,” [Online]. Available: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/aortic-valve-replacement-minimally-invasive. [Accessed 23 March 2020].
  11. e. a. JD Puskas, J Am Coll Cardiol, vol. 71, pp. 2717-26, 2018.
  12. e. a. J.E Murdock, “Nontransfemoral Approaches to Transcatheter Aortic Valve Replacement,” Int Cardiol Clin, pp. 95-105, 2015.
  13. e. a. R.R. Makkar, “Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement,” N Eng J Med, 2020.
  14. e. a. MJ Mack, N Eng J Med, vol. 380, pp. 1695-1705, 2019.
  15. J. Popma, “Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients,” NEJM, 2019.
  16. H. Ribeiro, “Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID Registry,” European Society of Cardiology, vol. 39, pp. 687-695, 2018.
  17. e. a. M Sharabiani, J Am Coll Cardiol, vol. 67, no. (24), pp. 2858-70, 2016.
  18. L. d. Freitas, “Long-Term Outcomes after Transcatheter Aortic Valve-in-Valve Replacement,” Circulation, 2018.
  19. S. Siu, “Bicuspid Aortic Valve Disease,” JACC, 2010.
  20. S. Yuan, “The unicuspid aortic valve,” Cardiovascular Journal of Africa, vol. 21, 2010.
  21. “Bicuspid Aortic Valve Disease,” [Online]. Available: https://my.clevelandclinic.org/health/diseases/16780-bicuspid-aortic-valve-disease. [Accessed 18 March 2020].
  22. P. Skillington, “The Ross procedure using autologous support of the pulmonary autograft: Techniques and late results,” JTCVS, vol. 149, 2015.
  23. A. v. r. a. a. v. replacement. [Online]. Available: https://www.mayoclinic.org/tests-procedures/aortic-valve-repair-aortic-valve-replacement/about/pac-20385093. [Accessed 23 March 2020].
  24. B. Fujita, “Impact of new pacemaker implantation following surgical and transcatheter aortic valve replacement on 1-year outcome.,” Eur J Cardiothorac Surg, 2020.