Evaluating the effect of renin-angiotension-aldosterone system inhibitors and beta blockers on the progression of bicuspid aortic valve aortopathy in adulthood: A retrospective cohort study.

Purpose: Patients with a bicuspid aortic valve (BAV) often have an associated aortopathy and increased risk of aortic dissection. This study aimed to assess if the chronic use of renin-angiotensin-aldosterone system inhibitors (RAASi) or beta blockers (BB) may be associated with reducing the progression of aortic dilation in adult BAV patients. Methods: A retrospective cohort study was performed including adult patients with BAV with serial echocardiography over ≥5 years. The cohort was subdivided according to chronic use of RAASi or BB. The primary outcome was a composite of progression of absolute ascending aortic diameter ≥4.5 cm or surgery for ascending aortic replacement. Results: Included were 262 patients with mean age of 54.3 ± 19.5 years and 75.1 % male. The average follow-up time was 10.8 ± 0.8 years. The cumulative incidence of the primary endpoint was 14.6 % at 10-year follow up and 33.3 % at 15-year follow up. While those with RAASi (n = 39) had the primary endpoint numerically less that those without RAASi chronic therapy (12.8 % vs 24.8 %, p = 0.147), on multivariate analysis there was no significant decreased risk for the primary outcome. (HR = 0.89, 95 % CI [0.34-2.86], p = 0.97). Similarly, there was no significant decreased risk of the primary outcome amongst those with chronic beta blocker use following multivariate analysis (HR = 0.96, 95 % CI [0.37-2.51], p = 0.95). Conclusions: Our findings suggest that the chronic use of RAASi or BB was not associated with a blunted progression of BAV aortopathy in the adult population. These results highlight the need for larger, randomised studies to validate these observations and further explore potential preventative strategies in this population.