Abstract
BACKGROUND: A bicuspid aortic valve (BAV) is a common congenital heart disease. The primary treatment for this condition involves the surgical replacement of both the aortic valve and the ascending aorta, typically through the Bentall procedure. Traditionally, the timing of surgery in patients with BAV and aortic dilation is based on the maximum ascending aortic diameter. However, numerous patients who experienced adverse outcomes did not fulfil the established surgical criteria, highlighting the necessity for new predictive factors to guide surgical decisions more effectively. Thus, this study aimed to identify alternative parameters in patients with BAV that could serve as early indicators of surgical intervention and to establish clear threshold values. METHODS: A retrospective analysis was conducted among 101 patients diagnosed with BAV at our institution between January 2004 and December 2023 who underwent follow-up computed tomography angiography. Demographic and clinical data were collected, focusing on the influence of ascending aortic volume on adverse outcomes, measured from the aortic annulus to the origin of the brachiocephalic artery. RESULTS: The average ascending aortic volume, length, and diameter were 99,496.51 mm(3), 90.94 mm, and 38.79 mm, respectively. Logistic regression analysis identified that only ascending aortic volume (p = 0.0338) and volume-to-height ratio (p = 0.0331) were significantly associated with adverse outcomes. In a multiple logistic regression model, the volume-height index (VHI) was independently associated with adverse outcomes (odds ratio (OR) 1.0008, 95% confidence interval (CI) 1.00023-1.00182; p = 0.048). Receiver operating characteristic (ROC) analysis determined the optimal cutoff value for the VHI as 66,340.5 mm(3)/m (area under the curve (AUC) = 0.797, 95% CI 0.676-0.896). The Kaplan-Meier curve showed that the event-free survival rate of patients with a VHI >66,340.5 mm(3)/m was consistently lower than that of the low VHI group; The difference between the two groups was statistically significant (log rank p < 0.0001). CONCLUSION: The VHI is a strong predictor of adverse outcomes in patients with a BAV and can guide surgical intervention decisions.