Patients characteristics and in hospital results
During the study period 666 consecutive BAV patients underwent elective thoracic aortic surgery. Of these 591 patients underwent root replacement (both valve sparring root replacement and Bentall procedure) or ascending aortic replacement combined with AVR and were excluded. The remaining 75 patients represent the focus of the study. Mean age was 56 ± 12 years. Most of the patients were male (N=42 75%) and had hypertension (56%). The mean left ventricular ejection fraction (EF) was 50,0 ± 5,27 and median left ventricular EDD was 60,0 [57,0-65,0]. Preoperative characteristics of the patients are listed in Table 1. The mean Valsava sinuses and STJ diameter were respectively 39,7 ± 4,01 mm and 35,9 ± 4,90 mm. A total of 33/75 patients (44%) had moderate aortic regurgitation, while 42/75 (56%) had mild aortic regurgitation. Mild aortic valve stenosis was detected in 5/75 (6,7%) patients and 3/75 (4%) patients had moderate aortic valve stenosis. These three patients were elderly and with a relative high surgical risk, the aortic gradients were at the inferior limit (mean gradient between 25 and 28 mmHg in all 3 patients) and intraoperatively the valve was relatively free of significant calcification, and for all these reasons the operating surgeon decided not to proceed with surgical AVR. The most common aortic valve phenotype in our patients was BAV type 0 antero-posterior (55/75, 73%), followed by BAV type 1 left-right (17/75, 23%) and BAV type 1 right-non coronary (3/75, 4%). Mitral valve repair, as concomitant procedure, was performed in 2 patients (2,5%) and coronary artery bypass grafting in 2 patients (2,5%). The median postoperative length of stay was 6 [4,5-7.5] days, no patient presented stroke or required re-exploration for bleeding and there were no in-hospital deaths, as shown in Table 2. Before discharge, all patients underwent trans-thoracic echocardiography and no significant differences in the degree of aortic regurgitation or stenosis were found.