Key result
TEE-based HOME score accurately predicts successful bicuspid aortic valve repair with an AUC of ~0.89.
Why the study?
Although several favorable anatomic and functional predictors for aortic valve repair in bicuspid aortic valve patients have been described, a standardized methodology for identifying patients with optimal characteristics for repair was lacking.
Does the transesophageal echocardiography-based HOME score accurately predict successful surgical aortic valve repair in patients with isolated bicuspid aortic valve regurgitation?
Observational (n=203)
No
Does the transesophageal echocardiography-based HOME score accurately predict successful surgical aortic valve repair in patients with isolated bicuspid aortic valve regurgitation?
The novel 9-point TEE-based HOME score provides a standardized and reliable method with high discriminative accuracy (AUC 0.89) to identify bicuspid aortic valve regurgitation patients who are likely to undergo successful valve-preserving surgical repair.
Answers are grounded in this paper and cite their sources.
May aid preoperative selection for bicuspid aortic valve repair; hypothesis-generating pending external validation.
Objectives Aortic valve (AV) repair has emerged as an increasingly adopted surgical alternative to aortic valve replacement (AVR) in bicuspid aortic valve (BAV) patients. Although several favorable anatomic and functional predictors have been described, a standardized methodology for identifying patients with optimal characteristics for AV repair is lacking. This study aims to develop and internally validate a novel scoring system - the HOME score - based on routine transesophageal echocardiography (TEE) to assess the likelihood of successful BAV repair of BAV repair. Methods We conducted a retrospective analysis of 203 consecutive patients who underwent surgery for isolated BAV regurgitation (2018-2024). Preoperative TEE parameters were systematically analyzed to identify factors associated with successful surgical repair. Results Four baseline TEE measurements emerged as powerful, independent parameters associated with BAV repair in multivariate analysis: geometric height≥18 mm (Odds Ratio [OR]: 8.05; 95% confidence interval (CI): 3.15 to 22.94; p=<0.001), commissural orientation≥140° (OR: 8.29; 95% CI: 2.67-25.67; p=<0.001), undamaged leaflets (OR: 20.4; 95% CI 6.59-63.53; p=<0.001), and preserved leaflet mobility (OR: 11.1; 95% CI: 3.98-31.45; p=<0.001). We integrated these findings into the simple, 9-point HOME score. The score demonstrated excellent discrimination for successful repair (Area Under the Curve = 0.89), effectively stratifying patients into groups with low (score 0 – 4), intermediate (5 – 6), and high (7 – 9) likelihoods of a valve-preserving surgery. Conclusions The HOME score may help identify BAV patients with a high probability of AV repair in a more standardized and reliable way. Its utility and accuracy require validation in larger, multicenter cohorts.
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G Italiano (2026) conducted an observational in Isolated bicuspid aortic valve (BAV) regurgitation (n=203). HOME score (preoperative transesophageal echocardiography parameters) vs. Aortic valve replacement (unsuccessful repair) was evaluated on Successful bicuspid aortic valve surgical repair (AUC 0.89). The 9-point TEE-based HOME score demonstrated excellent discrimination for predicting successful bicuspid aortic valve repair (AUC = 0.89).
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