Meta-analysis On Bicuspid Aortic Valve Phenotypes And Its Association With Aortic Valvular Dysfunction

Objective:To evaluate the association between bicuspid aortic valve(BAV)morphologic findings(RL vs RN,raphe vs nonraphe)and valve dysfunction.Methods:Detailed search was conducted according to the PRISMA(Preferred Reporting Items for Systematic reviews and Meta-Analyses)to search foreign database(PubMed,The Cochrane Library,Web of Science)and Chinese database(CNKI,Wanfang,Weipu)to November 31,2019 guideline to identify studies investigating the morphology of BAV and valvular dysfunction.At the same time,manually search for references included in the literature.Screening documents and extracting data.Meta-analysis using Stata 15.1software.Results: A total of 13 studies were included.Twelve studies on 2002 RL BAV vs1254 RN BAV and 4001 raphe vs 673 nonraphe patients were included.The RL BAV patients showed a higher incidence of aortic regurgitation than RN phenotype(OR,1.46;95% CI:1.12 to1.90;Z=2.83 P=0.005)and the Raphe+ BAV patients showed a higher incidence of aortic regurgitation than Raphe-phenotype in general population(OR=1.95,95%CI:1.12-3.39,P=0.017),Asian population(Raphe+ vs Raphe-,OR=3.47,95%CI:1.94-6.22,P=0.000;RL vs RN,OR=1.71,95%CI:1.26-2.32,P=0.00).The RL BAV patients showed a lower incidence of Aortic stenosis than RN phenotype in general population(OR,0.66;95% CI:0.58 to 0.76;Z=6.2 P=0.000),Asian population(RL vs RN,OR=0.62,95%CI :0.497-0.773,P=0.000)and European population(OR= 0.68,95%CI:0.49-0.95,P=0.022).However,The presence of fusion ridges was not associated with the risk of aortic valve stenosis in the general population or subgroup analysis.Conclusions: The RL and Raphe+ phenotype BAV patients was associated with increased aortic regurgitation risk in general population and Asian population.The RN phenotype BAV patients was associated with increased Aortic stenosis risk in general population,Asian population and European population.However,The presence of fusion ridges was not associated with the risk of aortic valve stenosis in the general population or subgroup analysis.