Goal 2: Reduce Human Disease

Controversies exist regarding the treatment of the thoracic aorta in those with bicuspid aortic valve

Controversies exist regarding the treatment of the thoracic aorta in those with bicuspid aortic valve (BAV), in particular: 1) conflicting views regarding criteria for elective surgery, particularly aneurysm size 2) extent of thoracic aortic aneurysm repair.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

This is a population that may approach 6 million Americans, without inclusion of their trileaflet aortic valve blood relatives. The controversy generally revolves around when to intervene surgically to prevent an aortic catastrophe, and how much of the ascending aorta should be removed (will any residual ascending aorta enlarge over time, and if so, what risk does this represent versus another aortic surgery later?).

Compounding this is the recognition in the literature of significant percentages of aortic dissection at sizes occurring below the guidelines for elective surgery. Patients do not realize that sometimes they are told to wait for elective surgery based on a size difference roughly as small as the thickness of a nickel (approximately 2 mm) or a dime (just over 1 mm).

The implications of this uncertainty in their treatment are staggering, particularly in light of the potential consequences for the most vulnerable individual, which include sudden death. Even those who survive an aortic emergency, with a chronically damaged aorta, face a very different future from that of someone with a non-emergent aortic repair with no residual aortic injury. Surgical uncertainty regarding the aorta should also consider valve surgeries needed by some individuals, and the total number of surgeries an individual may ultimately face.

Many with BAV are vibrant and active, if they avoid premature injury or death. Their disability or loss robs society of their many gifts.

Feasibility and challenges of addressing this CQ or CC

The medical literature reflects varying information and findings, perhaps due in part to the spectrum of expression across this large population, and the characterization of relatively small numbers of individuals under varied scenarios. Some may be carefully followed and receive medical treatment for blood pressure. Others may not receive those benefits, some being diagnosed only in emergency settings. Greater consistency in knowledge and treatment would benefit individuals and families. Advancements are very feasible within a five to ten year period and could greatly benefit the future of those undergoing surgery.

In the interim, patients are empowered when they understand these controversies: the known data regarding aortic size and dissection, and the considerations around the extent of aortic removal, and are fully engaged in elective surgery decisions.

Name of idea submitter and other team members who worked on this idea Arlys Velebir, Bicuspid Aortic Foundation

Annotations

Voting

-3 net votes
8 up votes
11 down votes
Active
Idea No. 622