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Uptodate Reference Title
Indications for prophylactic ascending aortic surgery for patients with bicuspid aortic valve
Indications for prophylactic ascending aortic surgery for patients with bicuspid aortic valve
These indications for prophylactic ascending aortic surgery apply to patients with bicuspid aortic valve without Turner syndrome. Separate recommendations for prophylactic aortic surgery with aortic size thresholds adjusted for body size apply to patients with Turner syndrome. Refer to the discussion of aortic dilation in the UpToDate topic on management of Turner syndrome.
* Aortic diameter is defined here as the maximum diameter of the ascending aorta at any level (including the aortic root and the tubular ascending aorta). Refer to UpToDate topic on general management of bicuspid aortic valve disease. ¶ High-risk features include family history of aortic dissection/sudden death, aortic growth rate >3.0 mm/year, aortic root aneurysm phenotype, coarctation of the aorta, predominant aortic regurgitation, and uncontrolled hypertension. Δ Low surgical risk is defined as an estimated surgical mortality risk of <4% with the procedure performed by an experienced surgical team and at a center with experience with these procedures. ◊ Refer to UpToDate topic on intervention for disease of the valve or aorta in bicuspid aortic valve disease. § The aortic valve surgery may be for aortic stenosis and/or aortic regurgitation. For patients undergoing a Ross procedure, a lower aortic diameter threshold of >4.0 cm is used to trigger concomitant repair of the aorta. ¥ The optimum ascending aorta diameter threshold for aortic surgery prior to pregnancy has not been established. Some experts would weigh the potential risks and benefits of surgical repair if the aortic diameter is ≥4.5 cm. ‡ Refer to UpToDate topic on pregnancy in women with bicuspid aortic valve.
