Effect of Bicuspid or Tricuspid Aortic Valve on Preoperative Coagulation in Patients Scheduled for Thoracic Aortic Surgery

Objectives: This study aimed to analyze the impact of aortic valve morphology on preoperative coagulation status in patients undergoing elective thoracic aortic surgery. Preoperative ROTEM and conventional coagulation tests of patients with a bicuspid aortic valve (BAV) were compared to those with a tricuspid aortic valve (TAV). Design: An exploratory prospective observational study. Setting: Conducted in a single center. Participants: The study included 169 patients (63 BAV and 106 TAV). Interventions: None. Measurements and Main Results: Mann-Whitney U tests were conducted to compare the groups. Regression analysis was performed to evaluate the association between valve morphology and abnormal ROTEM profiles. BAV patients were on average 10 years younger and had a median aortic diameter 5 mm smaller. No significant differences were found in preoperative ROTEM values or coagulation tests between groups, except for higher D-dimers in TAV patients. Sex was a significant confounder, and aortic diameter was a significant mediator. TAV patients required more red blood cell and platelet transfusions, likely due to more preoperative antiplatelet therapy and longer cardiopulmonary bypass times. Mortality and postoperative complications were similar between groups. Conclusions: Patients with a BAV have similar preoperative coagulation profiles and postoperative outcomes as TAV patients, based on ROTEM and conventional coagulation tests. While TAV patients required more RBC and platelet transfusions, this is likely due to factors other than valve type. These findings suggest that BAV patients do not need altered coagulation management despite structural differences and endothelial dysfunction.