A statement of clarification has been issued by the ACC and the American Heart Association (AHA), with endorsement from other societies, regarding differences between two guidelines that address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement. The statement was released Dec. 4 and published in the Journal of the American College of Cardiology.

The statement clarifies differences in the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease and the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. These guidelines differ in regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves.

Specifically, the clarification recommends that the operative intervention to repair or replace the aortic root (sinuses) or replace the ascending aorta is indicated in asymptomatic patients with bicuspid aortic valves (BAV) if the diameter of the aortic root or ascending aorta is 5.5 cm or greater.

Further, operative intervention to repair or replace the aortic root (sinuses) or replace the ascending aorta is reasonable in asymptomatic patients with bicuspid aortic valves if the diameter of the aortic root or ascending aorta is 5.0 cm or greater and an additional risk factor for dissection is present (e.g. family history of aortic dissection or aortic growth rate >0.5 cm per year) or if the patient is at low surgical risk and the surgery is performed by an experienced aortic surgical team in a center with established expertise in these procedures.

Finally, the authors clarify that replacement of the ascending aorta is reasonable in patients with bicuspid aortic valves undergoing aortic valve replacement because of severe aortic stenosis or aortic regurgitation when the diameter of the ascending aorta is greater than 4.5 cm. 

Keywords: Aorta, Aortic Diseases, Aortic Valve, Aortic Valve Insufficiency, Aortic Valve Stenosis, Dilatation, Heart Valve Diseases

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