Treatment of Bicuspid Aortic Valve in Ascending Phenotype Aortopathy with Aortic Coarctation
In low-surgical-risk patients with bicuspid aortic valve, ascending phenotype aortopathy with aortic coarctation lowers the diameter threshold at which surgical intervention is considered.
Clinical Scenario
Ascending phenotype bicuspid aortopathy is defined by aortic dilatation in which the tubular diameter exceeds the sinus diameter. At low surgical risk, the standard threshold for considering surgery is a maximum aortic diameter above 52 mm.
The threshold is reduced to 50 mm or more when any of the following modifying conditions is present:
- Age under 50 years
- Height between 1.50 and 1.69 m
- Ascending aortic length 11 cm or more
- Aortic diameter growth rate of 3 mm or more per year
- Family history of acute aortic syndrome
- Aortic coarctation
- Resistant hypertension
- Concomitant non-aortic-valve cardiac surgery
- Desire for pregnancy
Treatment Approach
The protocol in this scenario is centred on surgical management of bicuspid aortopathy. The full structured regimen — including procedural criteria, timing considerations, and decision thresholds — is available in the complete protocol.
References
DOI: 10.1093/eurheartj/ehae179
- In patients with low surgical risk, surgery for bicuspid aortopathy of ascending phenotype should be considered when the maximum aortic diameter is >52 mm.
- In patients with low surgical risk and ascending phenotype bicuspid aortopathy, surgery should be considered at a maximum diameter ≥50 mm if any of the following is the case: Age <50 years; Shorter stature; Ascending aortic length ≥11 cm; Aortic diameter growth rate ≥3 mm per year; Family history of acute aortic syndrome; Aortic coarctation; Resistant hypertension; Concomitant non-aortic-valve cardiac surgery; Desire for pregnancy.
- Ascending phenotype = aortic dilatation with tubular diameter > sinus diameter.
- Patient height between 1.50 and 1.69 m (yielding a CSA/h ratio >13 cm²/m).