Family screening for bicuspid aortic valve and aortic dilatation: a meta-analysis

Abstract Aims International guidelines recommend screening of first-degree relatives (FDR) of people with bicuspid aortic valves (BAVs). However, the prevalence of BAV and of aortic dilatation amongst family members is uncertain. Methods and results A systematic review and meta-analysis of original reports of screening for BAV. Databases including MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to December 2021 using relevant search terms. Data were sought on the screened prevalence of BAV and aortic dilatation. The protocol was specified prior to the searches being performed, and standard meta-analytic techniques were used. Twenty-three observational studies met inclusion criteria (n = 2297 index cases; n = 6054 screened relatives). The prevalence of BAV amongst relatives was 7.3% [95% confidence interval (CI) 6.1%–8.6%] overall and per family was 23.6% (95% CI 18.1%–29.5%). The prevalence of aortic dilatation amongst relatives was 9.4% (95% CI 5.7%–13.9%). Whilst the prevalence of aortic dilatation was particularly high in relatives with BAV (29.2%; 95% CI 15.3%–45.1%), aortic dilatation alongside tricuspid aortic valves was a more frequent finding, as there were many more family members with tricuspid valves than BAV. The prevalence estimate amongst relatives with tricuspid valves (7.0%; 95% CI 3.2%–12.0%) was higher than reported in the general population. Conclusion Screening family members of people with BAV can identify a cohort substantially enriched for the presence of bicuspid valve, aortic enlargement, or both. The implications for screening programmes are discussed, including in particular the substantial current uncertainties regarding the clinical implications of aortic findings. Structured Graphical Abstract Structured Graphical Abstract Left: prevalence estimates from meta-analysis for identification of bicuspid aortic valves (BAV) in screened relatives and identification of an affected family with at least one individual with newly found BAV per families screened, in addition to prevalence estimates for aortic dilatation of screened relatives overall and specifically amongst individuals also identified to have BAV or tricuspid aortic valves. Right: a visual representation of the estimated proportions of each finding from pooled screening programmes, by individuals (above) and by families screened (below). Audio Abstract 10.1093/eurheartj/ehad320_audio1 Audio Abstract ehad320_audio1 6335979465112