Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

Table 3

Criteria for elective replacement of the ascending aorta in patients with BAV.

AHA/ACC guidelines
Class I
(1) Aortic diameter >5.0 cm
(Level of evidence: B)
(2) Aneurysm growth rate >0.5 cm/year
(Level of evidence: B)
(3) Aortic diameter >4.5 cm with concomitant indication for elective aortic valve repair/replacement
(Level of evidence: B)
Aortic size ratios and indexes
Aortic diameters >4.5 cm and either of the following:
(1) Ratio of aortic area to body height >10 cm^2/m in asymptomatic patients with well-functioning BAV, or 8-9 cm^2/m in symptomatic patients [91]
(2) Ratio of aortic diameter to body surface area >4.5 cm/m^2 [92]
Other criteria (unvalidated)
Aortic diameters >4.5 cm and any of the following:
(1) Aortic coarctation, corrected or uncorrected [93]
(2) First-degree relative with ascending aortic dissection or rupture
(3) Long smoking history, especially with COPD [94, 95]