• aortic valve insufficiency
• aortic valve stenosis

Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly with a prevalence of up to 2%. Natural history and cardiac outcomes of people with BAV have been addressed in two large cohort studies, comparing them with age and sex-matched population estimates. Tzemos and colleagues1 in a study of 642 patients at a follow-up of 9 years showed that 25% of patients experienced a primary cardiac event with mainly intervention on the aortic valve and aorta. Similarly, Michelena and colleagues showed that a quarter of adults with BAV and no significant valve disease at baseline required cardiovascular surgery within 20 years of follow-up.2 Older age, moderate or severe aortic stenosis or regurgitation independently predicted the occurrence of a primary cardiac event. Half of their study population developed aortic root or ascending aortic dilatation. However, survival rates were not lower than for the general population.

There are several factors that can affect the type of treatment, outcome and survival in patients undergoing surgical aortic valve replacement (AVR) for BAV. These include age, valve morphology and pathophysiology, presence of concomitant coronary artery disease and ascending aortic and root aneurysm.

Glaser and colleagues3 in their study of 865 patients with BAV who underwent AVR report excellent survival which is similar to that of the general population at a maximum follow-up of 13 years. In a similar Swedish population study, Homgren and colleagues4 compared bicuspid with tricuspid aortic valve (TAV) in patients who had AVR and reported better prognosis in bicuspid morphology matching that of the general population. In their study, patients with BAV also had a lower 30-day mortality of 1% compared with 2.6% of patients with TAV.

The incidence of severe aortic stenosis is 4.5%/year in patients older than 65 years old. After the development of symptoms, …