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.