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Aortic valve-related aortopathy: assessing optimal timing of surgical intervention

Johannes Petersen1, Tatiana Sequeira-Gross1, Shiho Naito1

  • 1Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.

Expert Review of Cardiovascular Therapy
|October 9, 2019
PubMed

Insights

Optimal surgical timing for valve-related aortopathy is unclear. New biomarkers and flow pattern analysis may improve treatment decisions beyond traditional diameter measurements.

Area of Science:

  • Cardiovascular Medicine
  • Aortic Diseases
  • Valvular Heart Disease

Background:

  • Proximal aortic dilatation, termed valve-related aortopathy, frequently accompanies aortic valve diseases like bicuspid aortic valve and aortic stenosis.
  • Current criteria for surgical intervention based solely on aortic diameter are insufficient.
  • There is a need for advanced diagnostic tools to determine optimal surgical timing.

Purpose of the Study:

  • To review recent literature on valve-related aortopathies and optimal surgical intervention timing.
  • To highlight valve morphotype- and lesion-dependent aortopathies (bicuspid aortic valve vs. tricuspid aortic valve; stenosis vs. regurgitation).
  • To discuss novel diagnostic markers for improved clinical decision-making.

Main Methods:

  • Systematic literature search of PubMed and Embase databases up to July 2019.
  • Review of current treatment options for valve-related aortopathies.
  • Analysis of emerging serological and rheological markers.

Main Results:

  • Valve morphotype (bicuspid vs. tricuspid) and lesion type (stenosis vs. regurgitation) influence aortopathy characteristics.
  • Traditional diameter-based criteria have limitations in guiding surgical intervention.
  • Serological biomarkers and rheological markers of flow eccentricity show potential.

Conclusions:

  • A combination of serological biomarkers and quantitative rheological markers for transvalvular flow eccentricity may aid decision-making.
  • Future risk scores integrating aortic diameter, biomarkers, flow patterns, connective tissue status, and valve morphology could personalize treatment strategies for valve-related aortopathy.

Keywords:
AortopathyBAVaortic valve diseasebicuspid aortic valverheological biomarkersserological biomarkers

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