An innovative echocardiographic scoring system for bicuspid aortic valve repair.

Overview

OBJECTIVES: To develop and internally validate a novel scoring system for bicuspid aortic valve (BAV) reparability based on routinely collected transesophageal echocardiography (TEE) parameters. METHODS: We conducted a retrospective analysis of 203 consecutive BAV patients who underwent surgery for aortic regurgitation between 2018 and 2024. Ten preoperative TEE parameters associated with valve repair were systematically analyzed, significant variables were included in a multivariate analysis and then integrated into a scoring system. RESULTS: Four baseline TEE measurements emerged as independent parameters associated with BAV repair: geometric height ≥ 18 mm (Odds Ratio [OR] : 8.05; 95% confidence interval (CI):3.15 to 22.94; p = <0.001), commissural orientation ≥ 140° (OR : 8.29; 95% CI : 2.67-25.67; p = <0.001), good cusp quality (OR : 20.4; 95% CI 6.59-63.53; p = <0.001), and preserved cusp mobility (OR : 11.1; 95% CI : 3.98-31.45; p = <0.001). We integrated these findings into the simple, 9-point HOME score. The score demonstrated excellent discrimination for successful repair (Area Under the Curve = 0.89, 95% CI: 0.79-0.94), effectively stratifying patients into groups with low (score 0-4), intermediate (5-6), and high (7-9) likelihoods of a valve-preserving surgery. CONCLUSIONS: The HOME score may help identify BAV patients with a high probability of preserving surgery in a more standardized and reliable way.