Haemodynamic Assessment and Outcomes of Aortic Valvuloplasty for Aortic Regurgitation in Patients with Bicuspid Aortic Valve

<b>Background:</b> Aortic valvuloplasty for bicuspid aortic valve carries a risk of postoperative stenosis. We evaluated the haemodynamic differences between aortic valvuloplasty for bicuspid aortic valve, tricuspid aortic valve, and aortic valve replacement by echocardiography. We also assessed whether a higher postoperative pressure gradient affects the outcomes of aortic valvuloplasty for bicuspid aortic valve. <b>Methods:</b> From 2014 to 2021, patients undergoing aortic valvuloplasty were classified into aortic valvuloplasty for bicuspid aortic valve (Group-PB) and aortic valvuloplasty for tricuspid aortic valve (Group-PT). We also enrolled patients undergoing aortic valve replacement (Group-R) between 2002 and 2021. Mid-term outcomes were compared within Group-PB based on peak pressure gradients of ≥20 mmHg (subgroup-H) and <20 mmHg (subgroup-L). <b>Results:</b> Group-PB included 42 patients and Group-PT included 70 patients. Both 7-day and 1-year echocardiography showed the highest peak/mean pressure gradients in Group-PB (<i>n</i> = 41) and the lowest values in Group-PT (<i>n</i> = 67). Propensity scoring analysis yielded similar results to an unadjusted analysis. The mid-term outcomes were not significantly different between subgroup-H (<i>n</i> = 20) and subgroup-L (<i>n</i> = 22), with rates of freedom from aortic regurgitation >II at 5 years of 94.4% vs. 94.4% (<i>p</i> = 0.749) and freedom from reoperation of 94.4% vs. 100.0% (<i>p</i> = 0.317), respectively. <b>Conclusions:</b> Aortic valvuloplasty for tricuspid aortic valve shows favourable valve function in the early postoperative period, whereas aortic valvuloplasty for bicuspid aortic valve has a risk of postoperative stenosis. However, a high pressure gradient (peak pressure gradient of ≥20 mmHg) after aortic valvuloplasty for bicuspid aortic valve does not impact mid-term outcomes.