Surgical Threshold for Bicuspid Aortic Valve–Associated Aortopathy

Girdauskas, Evaldas; Borger, Michael A.

doi:10.1016/j.jcmg.2013.12.012

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…According to our results, the yearly progression rate of aortic dilatation was 0.019 mm/year regardless of baseline aorta size. The progression rate of AD obtained from our study is significantly lower than the average rate reported in previous studies (1.1 ± 0.15 mm/year), even after considering the heterogeneity of age and ethnicity of the study population [27,28]. A slower progression rate in our study may have resulted from our selected study population.…”

Section: Discussioncontrasting

confidence: 81%

“…In our study, we suggested a bicuspid AS progression model based on MPG rather than aortic valve area (AVA) because accuracy of AVA obtained by measuring multiple echocardiographic variables can amplify modeling errors. Although AVA has been well validated in both clinical and experimental studies, MPG is easier and simpler to measure and is accompanied by a smaller measurement error [26,27]. Therefore, we derived a bicuspid AS progression model based on MPG rather than AVA.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Disease Progression in Patients with Bicuspid Aortic Stenosis Using Mathematical Modeling

Kim

Chae

Shim

et al. 2019

JCM

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We aimed to develop a mathematical model to predict the progression of aortic stenosis (AS) and aortic dilatation (AD) in bicuspid aortic valve patients. Bicuspid AS patients who underwent at least two serial echocardiograms from 2005 to 2017 were enrolled. Mathematical modeling was undertaken to assess (1) the non-linearity associated with the disease progression and (2) the importance of first visit echocardiogram in predicting the overall prognosis. Models were trained in 126 patients and validated in an additional cohort of 43 patients. AS was best described by a logistic function of time. Patients who showed an increase in mean pressure gradient (MPG) at their first visit relative to baseline (denoted as rapid progressors) showed a significantly faster disease progression overall. The core model parameter reflecting the rate of disease progression, α, was 0.012/month in the rapid progressors and 0.0032/month in the slow progressors (p < 0.0001). AD progression was best described by a simple linear function, with an increment rate of 0.019 mm/month. Validation of models in a separate prospective cohort yielded comparable R squared statistics for predicted outcomes. Our novel disease progression model for bicuspid AS significantly increased prediction power by including subsequent follow-up visit information rather than baseline information alone.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Predicting Disease Progression in Patients with Bicuspid Aortic Stenosis Using Mathematical Modeling

Kim

Chae

Shim

et al. 2019

JCM

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“…BAV with aortic coarctation is associated with increased aortic risk 1 14 26. Aortic phenotype may be an important predictor of aortopathy 1 40. The aortic root phenotype (dilatation at the sinuses as opposed to the ascending aorta) is associated with more rapid aortic dilatation,41 aortic regurgitation42 and may have a genetic component 42.…”

Section: Prognostic Factors In Patients With Bav Aortopathymentioning

confidence: 99%

Surgical threshold for bicuspid aortic valve aneurysm: a case for individual decision-making

Adamo

Braverman

2015

Heart

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The bicuspid aortic valve (BAV) affects 1-2% of the population and may be associated with important valvular disease and an increased risk of aortic root and/or ascending aortic aneurysm and dissection. BAV aortic aneurysm and dissection occur earlier in life than when these disorders are associated with a tricuspid aortic valve (TAV). Alterations in the aortic media and differences in aortic elastic properties and wall stress also accompany BAV aortopathy. With appropriate follow-up and timely surgery, population studies have documented a survival rate for patients with BAV no different from age-matched controls. Guidelines have previously recommended prophylactic aortic surgery at a smaller aortic aneurysm size for patients with BAV compared with aneurysms in patients with a TAV. Recent guidelines have presented differing indications regarding the appropriate timing of prophylactic surgery for BAV aneurysms, giving the recommendation for surgery when the aortic root and/or ascending aortic exceeds 5.5 cm (unless certain factors are present), the same size for which TAV-associated aortic aneurysm surgery is recommended. We review the pathophysiology of BAV aortopathy, the clinical history of BAV ascending aortic disease, areas of uncertainty and make a case for a patient-centered, individualised decision regarding the optimal timing of aortic aneurysm surgery in BAV disease.

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“…This has significant implications, as the burden of surgery for BAV patients in the United States exceeds 1 billion dollars per year, and surgical intervention has doubled over the past decade (Opotowsky et al, 2013). It is noted that surgical planning and decision-making for BAV patients is affected by physician bias and historical local practice within institutions, which aren't always consistent and in line with guidelines (Verma et al, 2013; Della Corte et al, 2014b; Girdauskas and Borger, 2014; Michelena et al, 2014; Verma and Siu, 2014; Sundt, 2015; Wasfy et al, 2015). In a recent survey of 100 cardiac surgeons, it was postulated that attitudes on the etiology, inherited aortopathy vs. acquired from hemodynamic stress, rather than proven clinical evidence dictated surgical treatment of BAV aortopathy (Verma et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Fortunately, over the past 3 years, a concerted effort has been made in understanding the individual variability inherent to BAV disease and the role hemodynamic factors play in its manifestation and progression (Della Corte et al, 2014a; Fedak and Verma, 2014; Girdauskas and Borger, 2014; Martin et al, 2014; Uretsky and Gillam, 2014; Verma and Siu, 2014; Michelena, 2015; Spinale and Bolger, 2015; Itagaki et al, 2016; Sievers et al, 2016). There is a general consensus among experts regarding a critical need in developing personalized risk assessments beyond conventional aortic size and growth criteria, in delivering optimal care to BAV patients.…”

Section: Introductionmentioning

confidence: 99%

Evolution of Precision Medicine and Surgical Strategies for Bicuspid Aortic Valve-Associated Aortopathy

et al. 2017

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Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1–2% of people. BAV results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as bicuspid valve associated aortopathy. Bicuspid valve aortopathy is progressive and associated with catastrophic clinical events, such as aortic dissection and rupture. Therefore, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. However, the specific pattern of aortopathy is highly variable among patients, with different segments of the ascending aorta being affected. Individual patient risks are sometimes difficult to predict. Resection strategies are informed by current surgical guidelines which are primarily based on aortic size and growth criteria. These criteria may not optimally reflect the risk of important aortic events. To address these issues in the care of patients with bicuspid valve aortopathy, our translational research group has focused on validating use of novel imaging techniques to establish non-invasive hemodynamic biomarkers for risk-stratifying BAV patients. In this article, we review recent efforts, successes, and ongoing challenges in the development of more precise and individualized surgical approaches for patients with bicuspid aortic valves and associated aortic disease.

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Surgical Threshold for Bicuspid Aortic Valve–Associated Aortopathy

Cited by 5 publications

References 5 publications

Predicting Disease Progression in Patients with Bicuspid Aortic Stenosis Using Mathematical Modeling

Predicting Disease Progression in Patients with Bicuspid Aortic Stenosis Using Mathematical Modeling

Surgical threshold for bicuspid aortic valve aneurysm: a case for individual decision-making

Evolution of Precision Medicine and Surgical Strategies for Bicuspid Aortic Valve-Associated Aortopathy

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