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Review
. 2023 Mar 1;38(2):61-67.
doi: 10.1097/HCO.0000000000001020. Epub 2022 Dec 29.

Bicuspid aortic valve associated aortopathy: 2022 guideline update

Raj Verma  1 , Gideon Cohen  2 , Jillian Colbert  3 , Paul W M Fedak  3
Affiliations
Review

Bicuspid aortic valve associated aortopathy: 2022 guideline update

Raj Verma et al. Curr Opin Cardiol. .

Abstract

Purpose of review: Bicuspid aortic valve (BAV) disease is observed in 1-2% of the general population. In addition to valve-related complications (such as aortic stenosis and aortic regurgitation), individuals with BAV often develop dilatation of the proximal aorta (aortic root and ascending aorta), a condition termed BAV aortopathy. The development of BAV aortopathy can occur independent of valvular alterations and can lead to aneurysm formation, aortic dissection or aortic rupture. This review aims to update the clinician with an approach to BAV aortopathy decision making in keeping with the 2022 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline recommendations.

Recent findings: The ACC/AHA 2022 guidelines provide a contemporary and comprehensive approach to the diagnosis and treatment of aortic pathologies. We review the thresholds for replacement of the aortic root and/or ascending aorta along with the strength and level of evidence recommendations. We also review the various Class 2A and 2B recommendations for earlier intervention, which emphasize the importance of experienced surgeons, and multidisciplinary aortic teams (MATs).

Summary: BAV aortopathy is a common and heterogenous clinical problem. The decision making around timing of intervention requires a personalized approach that is based on the aortic dimensions, valve function, rate of growth, family history, patient factors, and surgical experience within MATs.

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References

    1. Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2018; 156:e41–e74.
    1. Michelena HI, Della Corte A, Evangelista A, et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. Eur J Cardiothorac Surg 2021; 60:448–476.
    1. Fatehi Hassanabad A, King MA, Di Martino E, et al. Clinical implications of the biomechanics of bicuspid aortic valve and bicuspid aortopathy. Front Cardiovasc Med 2022; 9:922353.
    1. Presti FL, Guzzardi DG, Bancone C, et al. The science of BAV aortopathy. Prog Cardiovasc Dis 2020; 63:465–474.
    1. Guzzardi DG, Verma S, Fedak PW. Bicuspid aortic valve aortopathy: mechanistic and clinical insights from recent studies. Curr Opin Cardiol 2017; 32:111–116.

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