Abstract 4123806: Early Findings on the Impact of Renin-Angiotensin-Aldosterone System Inhibitors on Bicuspid Aortic Valve Disease Progression: A Single Center Cohort Study

Introduction: Patients with a bicuspid aortic valve (BAV) often have an associated aortopathy, increasing their risk of aortic dissection. Currently, there is no proven therapy to stabilize the growth of BAV aortopathy. This study aimed to assess the effect of cardioprotective medications, specifically renin-angiotensin-aldosterone system inhibitors (RAASi), on the progression of aortic dilation in adult BAV patients. Methods: A retrospective cohort study was conducted including adult patients with BAV followed at our center between 1996-2020. All patients had echocardiography imaging with at least 5 years of follow-up. The cohort was divided based on the chronic use of RAASi, as determined by pharmacy check-out data. The primary endpoint was defined as either the progression of ascending aortic diameter ≥ 4.5 cm or surgery for ascending aortic replacement. Results: The study included 262 patients with a mean age of 54.3±19.5 years, of whom 75.2% (n=197) were male, and 34.7% (n=44) had a diagnosis of hypertension. At baseline, the average size of the ascending aorta was 4.2±4.1 mm and 3.5±4.0 mm at the level of the aortic sinuses. The average follow-up time was 5.8±0.8 years. During follow-up, 23 patients underwent ascending aortic replacement with concurrent aortic valve replacement, 66 patients experienced progression of ascending aortic diameter ≥ 4.5 cm, and 2 patients died. Patients using RAASi (n=40) had a lower incidence of the primary endpoint compared to those without RAASi chronic therapy (12.8% vs. 24.8%, p=0.147). Multivariate analysis indicated that patients without RAASi chronic therapy had a significantly increased risk of the primary endpoint (HR=2.87, 95% CI [1.03-8.01], p=0.43). Conclusions: Our early findings suggest that RAASi may have a preventative role in the progression of BAV aortopathy.