Hussain Arif, Warren Andrew E, Chen Robert P C, Dhillon Santokh S
Division of Cardiology, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada.
CJC Open. 2019 Apr 12;1(3):119-122. doi: 10.1016/j.cjco.2019.03.002. eCollection 2019 May.
Medical therapy is often prescribed to reduce the rate of aortic dilatation and prevent aortic dissection in patients with bicuspid aortic valve (BAV) despite a lack of evidence. We conducted an anonymous survey to gain insight into Canadian clinical practice regarding medical therapy used to slow the progression of aortic dilatation in patients with BAV.
A questionnaire was sent to 115 paediatric cardiologists and 18 adult congenital heart disease specialists in Canada.
Ninety of 113 paediatric cardiologists (80%) completing the questionnaire reported prescribing medication to reduce the rate of aortic dilatation. Some 75% (61/81) of them reported prescribing medications on the basis of aortic size scores, and 78% (48/61) considered medication at a score between ≥ 2 and < 5. The remaining 25% of responders (20/81) reported prescribing medications on the basis of absolute aortic diameter, and 80% (16/20) of them considered initiating medical therapy at an aortic diameter > 40 mm to < 50 mm. For practical purposes, however, 40% of respondents (45/113) would not or rarely consider medical therapy for this indication because of variation in the threshold for initiating treatment. Ten of 14 adult congenital heart disease specialists' responses (71%), reported prescribing medications who were excluded because of missing data.
The majority of Canadian paediatric cardiologists reported prescribing medications to slow the rate of aortic dilatation in patients with BAV. However, there is heterogeneity in the criteria to prescribe medical therapy. A multicenter randomized controlled trial is needed to establish the role of medical therapy in this patient population.
尽管缺乏证据，但医学治疗常被用于降低二叶式主动脉瓣（BAV）患者的主动脉扩张速率并预防主动脉夹层。我们进行了一项匿名调查，以深入了解加拿大在用于减缓BAV患者主动脉扩张进展的医学治疗方面的临床实践。
向加拿大的115名儿科心脏病专家和18名成人先天性心脏病专家发送了一份调查问卷。
在完成问卷的113名儿科心脏病专家中，有90名（80%）报告开具药物以降低主动脉扩张速率。其中约75%（61/81）报告根据主动脉尺寸评分开具药物，78%（48/61）在评分≥2且<5时考虑用药。其余25%的受访者（20/81）报告根据主动脉绝对直径开具药物，其中80%（16/20）在主动脉直径>40mm至<50mm时考虑开始药物治疗。然而，出于实际考虑，40%的受访者（45/113）不会或很少因开始治疗的阈值存在差异而考虑针对该适应症进行药物治疗。14名成人先天性心脏病专家的回复中有10名（71%）报告开具了药物，但因数据缺失被排除。
大多数加拿大儿科心脏病专家报告开具药物以减缓BAV患者的主动脉扩张速率。然而，在开具药物治疗的标准方面存在异质性。需要进行一项多中心随机对照试验来确定药物治疗在该患者群体中的作用。
