Evolving treatment options for valve and aortic disease with bicuspid aortic valve

Treatment decisions for patients with bicuspid aortic valves (BAVs) are unique for two principal reasons: (I) aortopathy with dilation of the proximal aorta is seen about 50% of cases, and frequently requires a combined repair; (II) patients are significantly younger than those undergoing treatment for acquired aortic valve disease, making the durability and lifestyle implications of treatment choices increasingly important (1). The traditional treatment for valve and aortic disease with BAV is composite or separate replacement of the valve and ascending aorta. While mechanical aortic valves are more durable, they require life-long anticoagulation. Bioprosthetic valves may be an even less attractive option for younger patients as primary valve failure has been reported in 26% of cases at 15 years (2). In this context, an alternative treatment approach with repair rather than replacement of the valve and aortic root, as proposed by Cosgrove et al. and later refined by Schafers et al. , is very appealing (3,4).