Diagnosis and Management of Bicuspid Aortic Valve Disease in Argentina: An Analysis Revealing the Need for Improvement

pp. 12-19

Abstract

Background: Bicuspid aortic valve (BAV), the most common congenital heart defect, presents a significant lifetime risk of cardiovascular complications. The extent to which healthcare professionals adhere to guidelines for managing BAV patients and the potential for significant heterogeneity in management between institutions in our setting remains unknown. The decision to recommend surgical treatment before complications arise increases the life expectancy of patients with BAV. Therefore, it is imperative to investigate these aspects in our setting. For this reason, a survey was designed to investigate the professional management of BAV in our country, including access to advanced diagnostic techniques, availability of multidisciplinary teams (Heart Teams), and adherence to clinical practice guidelines.

Objective: The primary objective was to determine the characteristics of the diagnosis and current management of BAV at the national level. The secondary objective was to identify regional differences in the diagnosis and management of BAV, as well as access to more complex diagnostic and surgical techniques.

Methods: An anonymous, voluntary survey was designed and distributed online to cardiologists in Argentina between May 2024 and January 2025. The questionnaire explored demographic and professional aspects, diagnostic practices (including family screening and multimodality imaging), and management strategies (availability of a Heart Team, type of interventions performed, prophylaxis of infective endocarditis, and genetic counseling). The responses of 240 professionals were analyzed using descriptive and comparative statistics.

Results: Most professionals surveyed were men (65%); mean age was 48.1 ± 12.2 years; 37.4% (n = 86) practiced in the Buenos Aires Metropolitan Area (AMBA), 27.4% (n = 63) in the province of Buenos Aires, and 5.7% (n = 13) in the province of Córdoba. Ninety-five percent (n = 228) had access to Doppler echocardiography, and 60.3 percent (n = 144) to multimodality imaging at their centers, which were mostly tertiary care institutions (p < 0.001).  According to 85.4% (n = 204) of respondents, patients are usually diagnosed in adulthood. Echocardiographic screening in first-degree relatives was requested by 60% of respondents, particularly by specialists in cardiovascular imaging (p = 0.001). Availability of Heart Teams for complex decision-making was limited (50%). This was more common in inland centers (61.7% vs. 43.3%; OR 2.1, 95% CI 1.2-3.6; p = 0.007) with no significant differences between public and private institutions. Access to a Heart Team was more frequent among professionals working in tertiary care centers (71.2% vs. 32.5%; OR 5.1, 95%: 2.9-8.9; p < 0.001). Indications for the Ross procedure and aortic valve replacement were uncommon, 40.7% reported having indicated transcatheter aortic valve implantation (TAVI) in some patients with BAV, despite limited evidence in this condition. Delayed surgical treatment of patients with BAV due to long waiting times was reported by 13% of survey respondents, especially in public institutions (p < 0.001). Adherence to current recommendations for prophylaxis of infective endocarditis was not uniform, and genetic counseling was rarely indicated (only in familial forms, in 47.1%).

Conclusion: The diagnosis and management of BAV in Argentina present significant challenges, including late detection, unequal access to advanced diagnostic and therapeutic resources, and variable adherence to clinical guidelines. (SEE THE FULL ABSTRACT AT THE PDF)