{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:28:22Z","timestamp":1791390502972,"version":"4.3.3"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,10,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Sex\u2010related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic\u2010clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic\u2010clinical stages remains undetermined.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Analysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35\u00b121\u00a0years, follow\u2010up 16\u00b17\u00a0years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51\u00b116\u00a0years, follow\u2010up 9\u00b16\u00a0years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62\u00b114\u00a0years, follow\u2010up 6\u00b15\u00a0years). For the community cohort, 20\u2010year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all\n              <jats:italic>P<\/jats:italic>\n              \u22640.04); for a total BAV\u2010related morbidity risk of 52\u00b14% vs 35\u00b16% in women (\n              <jats:italic>P<\/jats:italic>\n              =0.01). The cohort's 25\u2010year survival was identical to that in the general population (\n              <jats:italic>P<\/jats:italic>\n              =0.98). AR independently predicted mortality in women (\n              <jats:italic>P<\/jats:italic>\n              =0.001). Baseline AR was more common in men (\n              <jats:italic>P<\/jats:italic>\n              \u22640.02) in the tertiary cohort, with 20\u2010year survival lower than that in the general population (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001); age\u2010adjusted relative death risk was 1.16 (95% confidence interval [CI] 1.05\u20101.29) for men versus 1.67 (95% CI 1.38\u20102.03) for women (\n              <jats:italic>P<\/jats:italic>\n              =0.001). AR independently predicted mortality in women (\n              <jats:italic>P<\/jats:italic>\n              =0.01). Baseline AR and infective endocarditis were higher in men (both \u22640.001) for the surgical referral cohort, with 15\u2010year survival lower than that in the general population (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001); age\u2010adjusted relative death risk was 1.34 (95% CI 1.22\u20101.47) for men versus 1.63 (95% CI 1.40\u20101.89) for women (\n              <jats:italic>P<\/jats:italic>\n              =0.026). AR and NYHA class independently predicted mortality in women (both\n              <jats:italic>P<\/jats:italic>\n              \u22640.04).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Within evolving echocardiographic\u2010clinical stages, the long\u2010term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV\u2010related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.116.004211","type":"journal-article","created":{"date-parts":[[2016,9,30]],"date-time":"2016-09-30T01:20:10Z","timestamp":1475198410000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":72,"title":["Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts"],"prefix":"10.1161","volume":"5","author":[{"given":"Hector I.","family":"Michelena","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh M.","family":"Suri","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ognjen","family":"Katan","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackram F.","family":"Eleid","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u2010Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew J.","family":"Maurer","sequence":"additional","affiliation":[{"name":"Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Enriquez\u2010Sarano","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Mayo Clinic, Rochester, 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