Indications for prophylactic ascending aortic surgery for patients with bicuspid aortic valve

* 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). A threshold cross-sectional area of the aorta adjusted for the patient's height of ≥10 cm²/m at the level of the aortic root and ≥13 cm²/m at the level of the tubular ascending aorta may be helpful for identifying candidates for prophylactic aortic repair among individuals with taller or shorter than average stature (eg >1 standard deviation above or below the mean). Refer to the UpToDate topic on general management of bicuspid aortic valve disease.

¶ High-risk features include family history of aortic dissection, aortic growth rate ≥3.0 mm/year, aortic root aneurysm phenotype, coarctation of the aorta, predominant aortic regurgitation, and refractory uncontrolled hypertension.

Δ The procedure should be performed by an experienced surgical team and at a center with experience with these procedures.

◊ Aortic surgery may involve replacement of the aortic root, ascending aorta, or both. Refer to the 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.