Heterogeneity is the rule with bicuspid aortic valves, so op | Figure 1

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Heterogeneity is the rule with bicuspid aortic valves, so optimal surgical solutions vary by patient. Our experts share experience-based guidance for managing various presentations of bicuspid aortic valve and aortopathy:

If the valve is the primary indication for surgery (i.e., severe aortic stenosis and/or severe regurgitation):

  1. Replace the aorta if >45 mm in diameter.
  2. Replace the root too if it is >5 cm and AVR is being done. If the native valve is being retained, it needs to be stabilized, so the diameter threshold should be lowered to >45 mm.
  3. Sometimes thresholds need to be lowered further, depending on the quality of tissue or for a small patient, such as an individual with Turner syndrome or other syndromic connective tissue disorder.

If the aorta is the primary indication for surgery:

  1. Operate if the aorta is >5 cm in diameter or the cross-sectional area-to-height ratio is >10 cm2/m.
  2. Consider sparing the valve if it looks healthy, but address the root if >45 mm.
  3. Selectively lower thresholds.
  4. In some cases, parts of the arch should be resected because this may be curative.

More guidance for tailoring surgical strategy:

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