Introduction:
Bicuspid aortic valve (BAV) is the most common congenital heart disease, with a prevalence of 0.5-1-2% and a slight male predominance1-5. Many patients with BAV are asymptomatic and often present in adulthood as an incidental finding on echocardiogram. While survival in adult patients with BAV may not differ significantly from that of the general population (potentially due to the efficacy of AVR and similar interventions)3,6-8, patients with BAV are at an increased risk for various aortic pathologies including aortic stenosis (AS), aortic regurgitation (AR), aortic root dilation, aortic aneurysm, and aortic dissection1,3,9. A systematic review of 11,000 patients during 2-12 years of follow-up reported that aortic aneurisms were presents in 20-40% of patients with BAV, though less than 0.5% suffered a dissection5. Other studies report that up to 84% of patients with BAV may eventually develop an aortic aneurysm over the course of their lifetime, though less than 5% will have an aortic dissection10,11. The risk of various aortic pathologies has prompted guidelines to recommend surveillance of patients with BAV to guide timely intervention, but how closely these recommendations are being followed remains unknown.
The 2018 American Association for Thoracic Surgery (AATS) guidelines for the management of BAV recommend serial evaluations of the aorta by transthoracic echocardiogram (TTE) with intervals tailored to the presence and severity of aortic dilation9. The 2020 American College of Cardiology/American Heart Association (ACC/AHA) guidelines suggest lifelong surveillance in patients with aortic dilation ≥4.0cm, and MRI or CT evaluation of difficult to assess structures12. Additionally, surgery is often based on the severity of valvular pathologies7, for which the American Society of Echocardiography gives specific guidelines to assess and categorize13. Overall, all major cardiology/ cardiac surgery societies recommend careful clinical and imaging surveillance in BAV patients.
Although there is consensus on the necessity to carefully follow these patients, it is unknown how well current guidelines are adopted into clinical practice for incidentally detected BAV. Therefore, we aimed to understand the extent of clinical gap in implementation of guidelines-based surveillance for BAV patients at a tertiary care health system.
Materials and Methods: