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BAV Aortopathy Surgical Threshold — EECC MCQ

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ModerateAortic DiseaseBAV Aortopathy Surgical ThresholdEECC

A 50-year-old man with known bicuspid aortic valve and an ascending aortic aneurysm of 52 mm is being assessed. He has moderate AR but no symptoms. His brother had an aortic dissection at age 45. What is the surgical threshold for the ascending aorta in this scenario?

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Correct answer: B — Surgery is recommended at ≥50 mm in BAV patients with risk factors (family history of aortic dissection, coarctation, or growth >3 mm/year); without risk factors the threshold is ≥55 mm

The ESC 2024 Aortic Disease Guidelines and 2025 VHD Guidelines recommend a risk-stratified approach to ascending aortopathy in BAV: (1) ≥55 mm: surgery recommended regardless (Class I); (2) ≥50 mm with risk factors: surgery should be considered (Class IIa) — risk factors include family history of aortic dissection, coarctation of the aorta, growth >3 mm/year, or severe AR/AS requiring valve surgery; (3) ≥45 mm if concomitant cardiac surgery is planned. This patient has a 52 mm ascending aorta with a family history of dissection (his brother at age 45), meeting the ≥50 mm + risk factor criterion. TEVAR is NOT suitable for the ascending aorta (no adequate landing zones); open surgical repair with or without AVR is required.

Reference: ESC (2024): Aortic Disease Guidelines; ESC/EACTS (2025): VHD Guidelines