Bicuspid aneurysm size guideline

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that one is by: Matthew D. Solomon, MD, PhD1,2; Thomas Leong, MPH1; Sue Hee Sung, MPH1; et al

Not sure who Kim is .. though I did see him cited and in the references ...

I thought I'd reformat this for readability

Larger initial aortic size was associated with higher risk of AD and all-cause death in multivariable models, with an inflection point in risk at 6.0 cm.
Estimated adjusted risks of AD within 5 years were:
  • 4.0 to 4.4 cm - 0.3% (95% CI, 0.3-0.7) ,
  • 4.5 to 4.9 cm - 0.6% (95% CI, 0.4-1.3) ,
  • 5.0 to 5.4 cm - 1.5% (95% CI, 1.2-3.9) ,
  • 5.5 to 5.9 cm - 3.6% (95% CI, 1.8-12.8), and
  • > 6.0 cm 10.5% (95% CI, 2.7-44.3)
Rates of the composite outcome of AD and all-cause death were higher than for AD alone, but a similar inflection point for increased risk was observed at 6.0 cm.
Our data support current consensus guidelines recommending prophylactic surgery in nonsyndromic individuals with TAA at a 5.5-cm threshold.
In this study seems the risk of dissection is so low till 6cm.
I don't see that as low, even considering that I ride a motorcycle.

they support the consensus guidelines:

Further and getting back to: https://www.sciencedirect.com/science/article/pii/S1936878X13006724

Aortic Surgery for Ascending Aortic Aneurysms Under 5.0 cm in Diameter in the Presence of Bicuspid Aortic Valve

The title itself was enough to ask "are you BAV"? I don't see much in your bio

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It matters because as discussed here:

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106

3. There are additional risk factors for aortic dissection that may inform aortic surgical thresholds in patients with a BAV. A family history of aortic dissection10 and rapid aortic growth of ≥0.3 cm/y (when measured similarly with same technique) are both risk factors for aortic dissection. Patients with BAV and aortic coarctation have been reported to be at increased risk of aortic dissection,11 although in a recent report of 499 patients with BAV (mean age, 40±16 years), of whom 24% also had aortic coarctation, there was no difference in adverse aortic events between those with or without coarctation.12 Patients with dilation of the aortic root (“root phenotype”) represent 10% to 20% of patients with BAV and aortopathy and may have more rapid aortic growth and an increased risk of aortic complications.13,14 Because surgical aortic root replacement (and VSRR) is more complex than ascending aortic replacement, shared decision-making is often used when evaluating the risks and benefits of elective aortic root replacement at aortic diameters <5.5 cm.1,2,5,6
4. In patients with a BAV and indications for aortic valve intervention for stenosis or regurgitation, the data are limited regarding the degree of aortic dilation that warrants replacement of the aortic root, ascending aorta, or both at the time of AVR. Patients with a long life expectancy, low surgical risk, or with the root phenotype and predominant AR may benefit from concomitant prophylactic aortic repair. Conversely, for patients at higher surgical risk, especially those with aortic stenosis and only moderate ascending aortic dilation, the risks of concomitant aortic repair may not be warranted.
5. Limited data are available on the risk of aortic dissection among those with a BAV and aortic aneurysm diameter of 5.0 cm to 5.4 cm.5,15 Patient-related characteristics and surgical expertise may inform the timing of surgery, especially in low-risk patients with BAV and aortic aneurysms of 5.0 cm to 5.4 cm.1,2,5,6


HTH
 
Hi Pellicle the 5 year risk of 3.5 percent of dissection (5.5-5.9) , I am bicuspid and AVR was done 15 yrs back(severe AS/AR) and now aneurysm at 5.5 cm.i am being told surgical risk of up to 2 percent with other morbidities risk. Mind is so torn should I wait till 5.9 or so or should I go for surgery now itself .
 
Hi
At what size your aneurysm was repaired.

5.6 or something very like that

Second time surgery has higher mortality And morbidity risk

indeed ... and that surgery was my 3rd. I was cautioned to think "very carefully" about planning for a 4th "as good surgeons will not be lining up behind you to do that".

I have always felt I received good counsel from my earliest years (my bio)

HTH
 
Mortality and morbidity in surgery impacting now vs few years later
I suspected that ... you should know that at this stage the growth is non-linear and potentially unexptected. So when taking aim at that can make sure you know how far you're likely to kick it (vs putting your hip out when kicking)

174dbe06118e9055959f629020c453f2_w200.gif


Best Wishes
 
Hi


5.6 or something very like that



indeed ... and that surgery was my 3rd. I was cautioned to think "very carefully" about planning for a 4th "as good surgeons will not be lining up behind you to do that".

I have always felt I received good counsel from my earliest years (my bio)

HTH
After seeing the above kaiser study .. do you think it makes sense to wait or go for surgery.. surgeon here are making too much pressure to go for surgery
 
I suspected that ... you should know that at this stage the growth is non-linear and potentially unexptected. So when taking aim at that can make sure you know how far you're likely to kick it (vs putting your hip out when kicking)

174dbe06118e9055959f629020c453f2_w200.gif


Best Wishes
My size has been growing at same pace from last 7 years and has grown from 5.1-5.2 to 5.5-5.7 now. Almost .06-0.07mm per year .. so mind keep thinking if I want to wait i can wait for 4 years. But then also you will feel some degree of fear.
 
keep thinking if I want to wait i can wait for 4 years. But then also you will feel some degree of fear.
Please plan conservatively and allow for unexpected issues. I'm not sure how old you are, or how healthy you are other than your heart issues.

Are you sure that your overall health will support surgery 4 years from now? Will the recover be more difficult because of other health issues?

What if some outside issue causes an upset of the medical system, such as another pandemic? During covid a lot of surgeries were delayed for months, and it was a very dangerous time to be in a hospital if you could get surgery scheduled.

Good luck with whatever you decide to do!
 
Please plan conservatively and allow for unexpected issues. I'm not sure how old you are, or how healthy you are other than your heart issues.

Are you sure that your overall health will support surgery 4 years from now? Will the recover be more difficult because of other health issues?

What if some outside issue causes an upset of the medical system, such as another pandemic? During covid a lot of surgeries were delayed for months, and it was a very dangerous time to be in a hospital if you could get surgery scheduled.

Good luck with whatever you decide to do!
Hi I am 38 so age wise no issues. When I think of surgery I feel I only hqve 1 percent risk per year if I don't do it which is not great risk till 6cm. As surgery has 2 percent risk either ,but on other hand I need to do surgery some day by 6 cm and does it worth it the wait for few more years (but have certain family time)
 
After seeing the above kaiser study .. do you think it makes sense to wait or go for surgery.. surgeon here are making too much pressure to go for surgery
I think its dangerous to just extrapolate your own situation on studies when the "penalty" for getting your personal extrapolation wrong (in exchange for some short term uncertain benefits) is a very poor risk reward return ratio.

I would be guided by professional assessments. We are not doctors here and this particular issue most certainly falls into that realm.

You at the very least need to be monitoring frequently (perhaps monthly) to make sure you don't end up dead (or worse).

If you don't like what your team is suggesting then consult another provider.

Best Wishes
 
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I think its dangerous to just extrapolate your own situation on studies when the "penalty" for getting your personal extrapolation wrong (in exchange for some short term uncertain benefits) is a very poor risk reward return ratio.

I would be guided by professional assessments. We are not doctors here and this particular issue most certainly falls into that realm.

You at the very least need to be monitoring frequently (perhaps monthly) to make sure you don't end up dead (or worse).

If you don't like what your team is suggesting then consult another provider.

Best Wishes
My provider also gave me same number that risk of not doing surgery is 1 percent per year and risk of surgery is 2 percent, however he says if you wait for 4 years your risk is 4 percent and more than surgical risk of 2 percent. That's why super confused,does it worth surgery at this point ?
 
My provider also gave me same number that risk of not doing surgery is 1 percent per year and risk of surgery is 2 percent, however he says if you wait for 4 years your risk is 4 percent and more than surgical risk of 2 percent. That's why super confused,does it worth surgery at this point ?
What are your cardiologist and surgeon saying ... for its them I'd be guided by
 
They are suggesting surgery and reason behind is the same as I said that you have annual dissection risk of 1 percent at 5.5 and hence do surgery and take 2 percent risk once
seems reasonable to me (which is what I've been saying with "why take the risk of kicking the can down the road" when you can just take the surgical risk; which you'll eventually have to take ... unless you die before surgery)
 
5. Limited data are available on the risk of aortic dissection among those with a BAV and aortic aneurysm diameter of 5.0 cm to 5.4 cm.5,15 Patient-related characteristics and surgical expertise may inform the timing of surgery, especially in low-risk patients with BAV and aortic aneurysms of 5.0 cm to 5.4 cm.1,2,5,6


HTH
My hubbies aneurysm only measured 4.5, although the doctor adjusted that measurement to 4.7-4.8 when he reviewed the imaging. The lab report states his aorta had "medial myxoid degeneration" and states "gross separation of the aortic walls". Is this dissection?
 
seems reasonable to me (which is what I've been saying with "why take the risk of kicking the can down the road" when you can just take the surgical risk; which you'll eventually have to take ... unless you die before surgery)
Thanks Pellicle for the encouragement but easier said than done.. mind keep saying family is very young and something goes wrong in surgery how it will be dealt. Too much hard for me to make decision. Is there any more words of wisdom you have?
 
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