Assessment of aortic valve disease - a clinician oriented review

Table 6 Indication for surgery in patients with bicuspid aortic valve and aortic root disease[33,34,66,67]

Class of indication	Guideline		Differences between guidelines
	ESC/ EACTS 2012	AHA/ACC 2016 Consensus on AHA/ACC 2014, and ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM 2010 Guidelines
I	-	Asymptomatic bicuspid aortic valve with dilatation of Valsalva sinuses or the ascending thoracic aortic diameter > 55 mm	No class I indications in the 2012 ESC/EACTS guidelines
IIa	Bicuspid aortic valve with an ascending thoracic aortic diameter > 50 mm if the patient also has at least one of the followings: Family history of aortic dissection; documented increase in the aortic diameter > 2 mm/yr (assessed using the same imaging method, at the same level, and with comparative images available); arterial hypertension; coarctation of the aorta	Bicuspid aortic valve AND dilatation of the Valsalva sinuses or of the ascending thoracic aorta (> 50 mm) AND at least one of the following
		Family history of aortic dissection
		Documented increase in aortic diameter > 5 mm/yr
		OR low surgical risk in an expert center
	-	Replacement of the ascending aorta if the patient also has an indication for surgery for AS/AR, and the ascending aortic/Valsalva sinus diameter is > 45 mm	Not covered by the 2012 ESC guidelines

Class I: It is indicated, it is recommended; Class IIa: Should be considered, it is reasonable; Class IIb: May be considered; ESC: European Society of Cardiology; EACTS: European Association for Cardio-Thoracic Surgery; AHA/ACC: American Heart Association/American College of Cardiology; ACCF: American College of Cardiology Foundation; AHA: American Heart Association Task Force on Practice Guidelines; AATS: American Association for Thoracic Surgery; ACR: American College of Radiology; ASA: American Stroke Association; SCA: Society of Cardiovascular Anesthesiologists; SCAI: Society for Cardiovascular Angiography and Interventions; SIR: Society of Interventional Radiology; STS: Society of Thoracic Surgeons; SVM: Society for Vascular Medicine, North American Society for Cardiovascular Imaging; AR: Aortic regurgitation; AS: Aortic stenosis.