Abstract 13170: Bicuspid Aortic Valve Exacerbates the Ascending Aorta Aortopathy but Not Hypertension in Repaired Coarctation of the Aorta

Introduction: Coarctation of the aorta (COA) is a generalized vascular disease, associated with reduced aortic distensibility and a higher prevalence of systemic hypertension. 60-85% of COA patients have a bicuspid aortic valve (BAV). BAV is independently associated with lower aortic distensibility, but not hypertension (HTN). It is not known if the presence of a BAV accentuates the aortopathy and hypertension in CoA patients. Hypothesis: COA patients with a BAV have a stiffer aorta than those with a tricuspid aortic valve (TAV). Methods: We retrospectively identified COA patients with and without BAV in whom the cardiac MRI (CMR) data was available from 2005-2019 and calculated aortic distensibility at the ascending (AAO) and descending aorta (DAO). Patients with residual COA were excluded. Results: Among 215 COA patients (median age 25.3 years, 56% male), 67% of patients had a BAV. BAV and TAV groups were similar to the current age, gender, and modality of COA treatment. As expected, BAV patients had larger AAO size (median diameter z -score 1.4 versus 0.1, p<0.001). Median AAO distensibility z-score was significantly lower in the BAV group (-1.2 versus -0.7; p=0.014) but DAO distensibility was similar in BAV and TAV patients. The prevalence of HTN was not different between BAV (32%) and TAV groups (36%, p = 0.56). On multivariable analysis, HTN was not associated with BAV or AAO distensibility but was associated with lower DAO distensibility (p=0.01). Conclusions: In young adults with adequately treated COA, the BAV group had lower AAO distensibility and a larger AAO compared with the TAV group. However, DAO distensibility and the prevalence of hypertension were similar in BAV and TAV patients. These results suggest that although the presence of a BAV in COA exacerbates the AAO aortopathy in a localized fashion, it does not exacerbate the more generalized vascular dysfunction and associated HTN.