Introduction
Bicuspid aortic valve (BAV) is the most frequent congenital cardiac anomaly, with a prevalence of 1-2%1 in the general population. Aortic valve dysfunction and thoracic aortic disease are the most common complications associated with BAV. Within thoracic aortic aneurysms in BAV patients, supra-coronary aneurysm is the prevalent phenotype (60-70% of dilatated aortas)2,3. In patients with normal functioning BAV and supracoronary ascending aorta aneurysm the 2017 European Guidelines4 advise for isolated ascending aorta replacement , and two recent studies confirm good long-term function of the BAV 5,6,7. However, in patients undergoing supracoronary ascending aorta replacement with concomitant mild-to moderate BAV diseases, the indication to aortic valve replacement (AVR) is still a matter of debate. The aim of this study is to assess the long-term evolution of untreated mild and moderate BAV disease after isolated ascending aortic replacement.