Introduction: Patients with BAV are heterogeneous and risk prediction for the complications of valvulopathy and/or aortopathy remains challenging.
Methods: Adult patients who had undergone aortic or aortic valve surgery for BAV were identified from our Adult Congenital Heart and Cardiothoracic Surgery databases. BAV morphology was classified according to the number of raphes present according to the Sievers classification [1].
Results: 571 patients were included (73.4% males, median age at surgery 62 years). The commonest indication for surgery was aortic valve dysfunction (69.5%) followed by aortic disease (15.2%). The commonest haemodynamic abnormality was aortic stenosis (74.4%), then aortic regurgitation (13.1%). 36.6% required aortic surgery in addition to valve replacement. 24.7% of patients had concomitant CABG. 30-day mortality was 1.4%, in patients with and without aortic replacement surgery.
Data on BAV morphotype was available in 346 patients (60.6%); one raphe (type 1) in 82.1%, no raphes (type 0) in 7.2% and two raphes (type 2) in 2.3%. Patients with type 2 valves were significantly younger at time of surgery than patients with type 1 valves (36 vs 63 years, p = 0.008). Patients with type 0 valves were much more likely to require aortic surgery than patients with type 1 valves (68% vs 37.3%, p = 0.005) and were more likely to require both proximal and distal aortic replacement (p = 0.014).
Conclusion: A significant number of patients undergoing surgery for BAV had associated aortopathy requiring aortic surgery. BAV morphology influenced age at valve surgery, and the need for aortic surgery.
