Update on biomarkers of bicuspid aortic disease: still a long road to run?

Management criteria of patients with aortopathy are based mainly on dimensional parameters, namely aortic diameter and growth rate (1), with the rationale that elective treatment is aimed at preventing acute aortic events (AAEs), i.e., aortic dissection or rupture, and that the risk of AAEs is predicted by the aortic diameter. However, this principle has been questioned by some evidence: the majority of acute aortic dissections occur at diameters well below the threshold for prophylactic surgery, and their number may be even underestimated since an acute increase in aortic diameter occurs as the aorta dissects (2).