Indexed Aortic Area in Bicuspid Valve Disease
An Important Step Toward a More Personalized Approach to Risk Prediction and Clinical Decision Making
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Never put off until tomorrow what you can do the day after tomorrow.
The decision to undertake thoracic aortic repair in patients with progressive aortic dilation in the setting of bicuspid aortic valvular disease remains a point of much discussion and continuing investigation. The ongoing work to find an optimal cutoff value for intervention that balances surgical risk and risk of dissection or rupture to optimize patient care is perhaps best reflected in the most recent American College of Cardiology/ American Heart Association guidelines (2014) that recommended a 5.5 cm threshold for surgery in regard to patients with bicuspid valves.1 This is a notable change from the 2010 guidelines which cited a 5 cm threshold.2 These thresholds have informed clinical decisions for decades but are inherently limited because they do not adjust for patient size (body surface area or height) or sex. Growing awareness of the limitations of unadjusted 2-dimensional measurements of the aorta has driven a desire …