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

ABSTRACT

Introduction: Dilatation of the proximal aorta is often associated with an aortic valve disease (e.g. bicuspid aortic valve, aortic stenosis), so-called ‘valve-related aortopathy.’ The definition of optimal timing for surgical intervention in valve-related aortopathy remains incompletely clarified. The limited value of traditional diameter-based intervention criteria has been recognized and more sophisticated diagnostic tools are necessary.

Areas covered: This article aims to give an overview on the most recent literature addressing the different forms of valve-related aortopathies and the optimal timing of surgical intervention. It highlights the valve morphotype-dependent (BAV vs TAV) and the valve lesion-dependent aortopathies (stenosis vs regurgitation) and outlines the current treatment options of those pathologies. Further, this review discusses novel serological and rheological markers, potentially helping in the decision-making process in valve-related aortopathy. Systematic literature searches were performed using PubMed and Embase up to July 2019.

Expert opinion: The combination of serological biomarkers and quantitative rheological markers for transvalvular flow eccentricity might be an additional useful tool. A possible solution for the future could be a risk score which considers body-surface-adjusted aortic diameters, activity of certain circulating biomarkers, transvalvular flow patterns, possible connective tissue disorders, and the valve morphology to define an individualized treatment strategy.

KEYWORDS:

• Aortopathy
• bicuspid aortic valve
• BAV
• aortic valve disease
• serological biomarkers
• rheological biomarkers

Article highlight

• Definition of optimal timing for surgical intervention in valve-related aortopathy remains unclear

• Limited value of traditional aortic diameter-based intervention criteria

• Assessment of connective tissue disorders and valve morphology (e.g. BAV phenotypes) is necessary to estimate the risk of aortic events

• Serological biomarkers and quantitative rheological markers for transvalvular flow eccentricity might be an useful additional tool

• A potential risk score for valve-related aortopathy could help to define an individualized treatment strategy

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.