Knowledge, attitudes, and practice patterns in surgical management of bicuspid aortopathy: A survey of 100 cardiac surgeons

Abstract

This large survey uncovered significant gaps in the knowledge and attitudes of surgeons toward the diagnosis and management of bicuspid aortopathy, many of which were at odds with current guideline recommendations. Efforts to promote knowledge translation in this area are strongly encouraged.

Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Versus Marfan Syndrome

“…Bicuspid valves degenerate more frequently and rapidly than trileaflet aortic valves, and recent clinical history data suggest that as many as 50% of patients with echocardiographic diagnoses of bicuspid aortic valve eventually require aortic valve replacement (AVR) (2,3). The incidence of ascending aortic dissection in patients with bicuspid aortic valves is estimated to be 8 times higher than that in the general population (2), but single-center studies focusing on the long-term risk for dissection after isolated AVR in patients with bicuspid aortic valves have yielded conflicting outcome data (4)(5)(6)(7)(8), so the indications for concomitant intervention on the thoracic aorta at the time of AVR are controversial (9). Histopathologic similarities between specimens of aneurysms from patients with bicuspid aortic valves and Marfan syndrome (10,11) have led to the extrapolation of treatment algorithms for management of the ascending aorta in bicuspid aortic valve disease from aggressive guidelines established for the management of Marfan syndrome (12,13), despite the lack of supporting comparative clinical outcome data (14,15).…”

The Association Between Aortic Valve Leaflet Morphology and Patterns of Aortic Dilation in Patients With Bicuspid Aortic Valves

“…Although aortic stenosis (AS) and aortic insufficiency (AI) are the most common complications of a BAV, dilation of any or all segments of the proximal aorta from the aortic root to the aortic arch, called bicuspid aortopathy, is also present in approximately 40% to 50% of affected persons [10,11]. The majority of young patients with BAV have mild dilation; the rare patient can have progressive dilation that places them at risk for morbidity and premature death [7,12].…”

Aortic valve disease with ascending aortic aneurysm: Impact of concomitant root-sparing (supracoronary) aortic replacement in nonsyndromic patients

“…In case of the co-incidence of both diseases (diseased aortic valve and aorta), it still remains controversial whether a more preventive approach or a more restrained posture regarding the aorta is indicated. 11 Opponents of an aggressive approach argue that a concomitant aortic replacement increases the operative risk compared with an isolated valve replacement.…”