Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany ; Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
Cardiol Res Pract. 2012;2012:313879. doi: 10.1155/2012/313879. Epub 2012 Sep 20.
Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45 mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50 mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ≥45 mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ≥50 mm, or if the aneurysm is rapidly progressing (rate of 5 mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated-or ectatic-ascending aorta.
在患有二叶式主动脉瓣（BAV）的患者中，对中度扩张的升主动脉/主动脉根部进行预防性外科修复存在争议。目前，大多数国际参考中心建议对最大升主动脉/根部直径为 45mm 的 BAV 患者采取积极主动的方法，因为当动脉瘤直径>50mm 时，夹层/破裂的风险显著增加。欧洲心脏病学会（ESC）的现行指南和美国心脏病学会（ACC）/美国心脏协会（AHA）的联合指南建议对功能失调的 BAV（主动脉直径≥45mm）患者进行有症状的选择性修复。对于无症状且功能良好的 BAV 患者，如果直径≥50mm，或动脉瘤快速进展（每年 5mm），或有夹层/破裂/猝死的强烈家族史，或计划怀孕，则建议进行选择性修复。由于直径可能不是破裂和夹层的最可靠预测指标，而且大多数 BAV 患者在小直径时可能永远不会经历主动脉灾难，因此过于积极的方法几乎肯定会使一些 BAV 患者不必要地面临手术和早期死亡的风险。本文讨论了在患有中度扩张或扩张性升主动脉的 BAV 患者中预防性、选择性修复主动脉根部和升主动脉的适应证。
