Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia
Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45 mm si...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2012-01-01
|
| Series: | Cardiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/313879 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832563378919309312 |
|---|---|
| author | Christian D. Etz Martin Misfeld Michael A. Borger Maximilian Luehr Elfriede Strotdrees Friedrich-Wilhelm Mohr |
| author_facet | Christian D. Etz Martin Misfeld Michael A. Borger Maximilian Luehr Elfriede Strotdrees Friedrich-Wilhelm Mohr |
| author_sort | Christian D. Etz |
| collection | DOAJ |
| description | Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45 mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50 mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ≥45 mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ≥50 mm, or if the aneurysm is rapidly progressing (rate of 5 mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated—or ectatic—ascending aorta. |
| format | Article |
| id | doaj-art-b41580f0ed94490f9c69b73d76926020 |
| institution | Kabale University |
| issn | 2090-8016 2090-0597 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cardiology Research and Practice |
| spelling | doaj-art-b41580f0ed94490f9c69b73d769260202025-02-03T01:20:26ZengWileyCardiology Research and Practice2090-80162090-05972012-01-01201210.1155/2012/313879313879Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic EctasiaChristian D. Etz0Martin Misfeld1Michael A. Borger2Maximilian Luehr3Elfriede Strotdrees4Friedrich-Wilhelm Mohr5Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, GermanyPreventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45 mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50 mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ≥45 mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ≥50 mm, or if the aneurysm is rapidly progressing (rate of 5 mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated—or ectatic—ascending aorta.http://dx.doi.org/10.1155/2012/313879 |
| spellingShingle | Christian D. Etz Martin Misfeld Michael A. Borger Maximilian Luehr Elfriede Strotdrees Friedrich-Wilhelm Mohr Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia Cardiology Research and Practice |
| title | Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia |
| title_full | Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia |
| title_fullStr | Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia |
| title_full_unstemmed | Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia |
| title_short | Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia |
| title_sort | current indications for surgical repair in patients with bicuspid aortic valve and ascending aortic ectasia |
| url | http://dx.doi.org/10.1155/2012/313879 |
| work_keys_str_mv | AT christiandetz currentindicationsforsurgicalrepairinpatientswithbicuspidaorticvalveandascendingaorticectasia AT martinmisfeld currentindicationsforsurgicalrepairinpatientswithbicuspidaorticvalveandascendingaorticectasia AT michaelaborger currentindicationsforsurgicalrepairinpatientswithbicuspidaorticvalveandascendingaorticectasia AT maximilianluehr currentindicationsforsurgicalrepairinpatientswithbicuspidaorticvalveandascendingaorticectasia AT elfriedestrotdrees currentindicationsforsurgicalrepairinpatientswithbicuspidaorticvalveandascendingaorticectasia AT friedrichwilhelmmohr currentindicationsforsurgicalrepairinpatientswithbicuspidaorticvalveandascendingaorticectasia |