Bicuspid aortic valve surveillance

Patients with congenital bicuspid aortic valve (BAV) disease are at increased risk of aortic root dilation, aneurysm, rupture, and dissection. Not all patients with BAV require immediate surgery, but careful monitoring is a necessary component of care to track progression of the disease.

The Surveillance Clinic at the Penn Center for Bicuspid Aortic Valve Diseases was designed to simplify monitoring. Led by advanced practice providers, Clinic staff monitor aortic dilation, adjust treatments, and, when needed, help patients prepare for surgery and recovery. The program has streamlined surveillance and led to increased return rates for patients with BAV.

“Monitoring, for patients with aortic disease, is crucial,” says Melanie Freas, DNP, CRNP, Clinical Program Manager at the Center for Bicuspid Aortic Valve Diseases at the Penn Heart and Vascular Center. “These conditions can change, and whether they require surgery or not, they still need to be followed.” She adds that the Clinic has expanded its efforts to ensure that every patient receives consistent and beneficial follow-up care.

Freas joined the Penn Medicine Physician Interviews Podcast to discuss how the surveillance clinic is benefiting patients.

Surveillance and support

Patients referred to the Clinic begin by meeting with a surgeon to determine whether they need surgery right away. If not, they continue in the surveillance program, coming in for monitoring at one- to two-year intervals.

Establishing a clinic led by advanced practice providers (APPs) has made it easier for patients to access essential monitoring. “By creating the surveillance clinic, we were able to significantly decrease wait times for patients,” Freas notes. “We also provide a more relaxed atmosphere where patients and their families can receive individualized attention and education.”

Data underscores the program’s impact. Between 2018 and 2019, before the Clinic was launched, 82 percent of BAV patients returned to Penn’s surgical clinics for recommended follow-ups. When patients began attending the APP-run clinics, the return rate increased to 98 percent.

Freas attributes the increased return rate to improved scheduling and better patient education. “We take the time to answer questions—simple things like ‘What exercises can I do?’ and ‘How can I live my life moving forward?’” she says. “It’s a very trusting, patient-focused atmosphere.”

Expert opinions at Penn Medicine

The Penn Aorta Center currently runs three advanced practice Clinics. In addition to the BAV clinic, there is a program for general thoracic surveillance launched in 2004, and the newest Clinic, for patients who have had aortic dissections. Together, they follow about 1,400 patients each year, many of whom have been returning for surveillance for a decade or more.

“We’ve put a lot of time into the infrastructure to keep track of all these patients. It’s no longer a disease-focused model, but a patient-focused one,” Freas says.

Advanced practice clinics are becoming more common, not only in cardiac care but in other fields of medicine as well. The success of Penn’s surveillance clinics has not gone unnoticed, Freas says. She and her colleagues have hosted clinicians from around the country and outside the U.S. who are interested in establishing similar programs.

Experts at the Penn Aorta Center work closely with referring providers to coordinate patient care. The surveillance program does not replace other healthcare providers, and patients are still followed by their primary cardiologist, Freas adds. “This is important because it coordinates care to ensure that we’re all on the same plan. We’re just here to give them an expert surgical opinion,” she says.

Clinical consultations and referrals

Patients can receive treatment via the Bicuspid Aortic Valve Disease Center at Penn Medicine’s Philadelphia campus as well as a satellite office in Radner. For a provider-to-provider consultation with the Melanie Freas, NP, call 877-937-7366, or refer a patient online. For consultation with the Bicuspid Aortic Valve Disease Center, call 877-736-6228.