Treatment of dilatation of the ascending aorta: Bicuspid versus tricuspid aortic valve pathologies

Background: The development of individualized treatment concepts necessitates better risk prediction models for adverse aortic events and patient-tailored treatment strategies for dilatation of the ascending aorta. Objectives: This article provides an overview of traditional and modern markers for risk prediction of adverse aortic events and the state of the art evidence for specific treatment concepts of bicuspid versus tricuspid valve aortopathies. Material and methods: A systematic analysis of the current literature was carried out taking into account the implementation of modern biomarkers for risk prediction of adverse aortic events and differentiated treatment concepts for bicuspid versus tricuspid valve aortopathies. Results: The maximum cross-sectional aortic diameter alone is insufficient to provide reliable information for risk stratification with respect to the aortopathy, especially considering the heterogeneous nature of ascending aortic disease. The current literature indicates the presence of marked heterogeneity in the symptoms of diseases of the bicuspid aortic valve, which have different origins and a different prognosis and can therefore necessitate a specialized form of treatment. Based on the study results from recent years there are clear parallels between bicuspid and tricuspid valve aortopathies which, however, have not yet been investigated in prospective studies. Conclusion: The individualized risk analysis and therapy decision-making process for dilatation of the ascending aorta necessitate the future establishment of prognosis-based biomarkers in combination with traditional risk factors. © 2016, Springer-Verlag Berlin Heidelberg.