Bicuspid Aortic Valve: Current Therapeutic Strategies

Abstract

Bicuspid aortic valve (BAV) is the most common congenital valvular pathology with an incidence of 1–2% in the general population. It is associated with an ascending aortic aneurysm phenotype in 26–50%, and aortic root (+/− ascending aneurysm) phenotype in up to 20–32% of patients. Bicuspid aortic valve patients present with a spectrum of valvular, ascending, and aortic root aneurysmal pathophysiologies. This variable spectrum has mandated the development of an array of surgical procedures to be able to tailor an individualized approach to BAV syndrome for a typically younger BAV population in which long-term outcomes are especially relevant . This chapter will delineate the current evidence-based surgical therapeutic strategies for patients with a BAV syndrome of aortic valve stenosis or insufficiency phenotype and aortic phenotype pathophysiology and include aortic valve replacement, aortic valve repair, aortic valve and supracoronary ascending aorta replacement (AVRSCAAR), Bentall procedure, and valve-sparing root reimplantation.