Debate Continues on Key Issues for Treating Bicuspid Aortic Valves

As the treatment of bicuspid aortic valve (BAV) disease evolves, the cardiothoracic surgery community remains split on key issues, such as remodeling versus reimplantation for BAV associated with aortic insufficiency and root aneurysm, as well as the indication for resection in BAV aortopathy.

EACTS @ STS: Bicuspid Aortic Valve Repair With Aortic Valve Insufficiency and Proximal Aortic Aneurysm Repair

Tuesday, January 30
1:00 p.m. – 3:00 p.m.
Floridian Ballroom D

These are some of the topics to be discussed during today’s EACTS @ STS session, which will be moderated by leaders of both societies: STS Past President Joseph E. Bavaria, MD and European Association for Cardio-Thoracic Surgery Vice-President Ruggero De Paulis, MD.

Joseph E. Bavaria, MD

BAV is the most common congenital heart defect, with a prevalence of 1% to 2% in the general population. “The prevalence of BAV makes it important for cardiothoracic surgeons to know about advances in surgical repair and reconstruction,” Dr. Bavaria said. “We borrowed from the mitral valve history, where we now strive to repair most insufficient mitral valves. So the question before us is whether we can apply the same logic to the aortic valve.”

The session is a “meeting ground” of North American and European schools of thought on root aneurysm, said Dr. Bavaria, and a debate will focus on reimplantation versus remodeling for BAV aortic insufficiency with root aneurysm. Each of these approaches has its advantages and disadvantages, but the differences between the two have narrowed over time because of advances in techniques. The debate will help to clarify the clinical scenarios in which each approach is best.

Another ongoing debate among cardiothoracic surgeons relates to the resection diameters in BAV aortopathy. North American and European guidelines differ in their recommendations for cutoff diameters, and practice varies. Speakers will address factors in decision making regarding resection.

“World-renowned experts will take a deep dive into sophisticated content on decision making, as well as surgical techniques. Presentations will be very nuanced, with clinical pearls that attendees can apply to practice,” said Dr. Bavaria.

Detailed descriptions of aortic root and leaflet anatomy will be presented, along with a discussion of the geometry of repairs in relation to commissural angles and the proper annular dimensions—points that are important to the successful execution of the procedure. Also discussed will be different decision strategies according to various Sievers classifications, factors that contribute to poor and good outcomes, and the mid-term and long-term determinants of failure.