Alessandro Della Corte, MD, PhD, Simon C. Body, MBChB, MPH, Anna M

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Surgical treatment of bicuspid aortic valve disease: Knowledge gaps and research perspectives Alessandro Della Corte, MD, PhD, Simon C. Body, MBChB, MPH, Anna M. Booher, MD, Hans-Joachim Schaefers, MD, Rita K. Milewski, MD, PhD, Hector I. Michelena, MD, Arturo Evangelista, MD, PhD, Philippe Pibarot, DVM, PhD, Patrick Mathieu, MD, Giuseppe Limongelli, MD, PhD, Prem S. Shekar, MD, Sary F. Aranki, MD, Andrea Ballotta, MD, Giuseppe Di Benedetto, MD, Natzi Sakalihasan, MD, PhD, Gianantonio Nappi, MD, Kim A. Eagle, MD, Joseph E. Bavaria, MD, Alessandro Frigiola, MD, Thoralf M. Sundt, MD The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 6, Pages 1749-1757.e1 (June 2014) DOI: 10.1016/j.jtcvs.2014.01.021 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The research approach to BAV aortopathy: past and future. Up to a few years ago, research on BAV aortopathy interpreted clinical aspects (eg, rate of progression, relation with severity of valve dysfunction, risk of dissection) with the aim of drawing inferences on the pathogenesis, that is, alternatively supporting the hemodynamic or the genetic theory. Inconclusive results and increasing awareness of the phenotypic heterogeneity have led to an inversely oriented approach: the contribution of either pathogenetic factor is investigated to identify the respective potential prognostic value in the clinical setting.6 AVR, Aortic valve replacement; BAV, bicuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1749-1757.e1DOI: (10.1016/j.jtcvs.2014.01.021) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Borderline conditions. Intraoperative photographs from a patient with dilated ascending aorta (left: 50 mm at the midascending tract bulging toward the right and anteriorly, 35 mm at the sinotubular junction, 38 mm at sinuses, and normal distal ascending and arch diameters) and BAV (right: fusion of the right and left coronary leaflets, partial fibrous noncalcific raphe, a nearly 180° position of the commissures, no stenosis, and trivial regurgitation at echocardiography). According to published series, different investigators would treat this unique condition by a variety of techniques, including simple ascending replacement, ascending reduction aortoplasty, ascending and root replacement with valve sparing, Wheat operation, Bentall operation, and so forth.7 The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1749-1757.e1DOI: (10.1016/j.jtcvs.2014.01.021) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions