Comparison of BAV and TAV Aortic Disease

Our study included a population of 70 BAV subjects (50 males and 20 females; mean age: 58.8 ± 14.8 years) and 70 TAV subjects (35 males and 35 females; mean age: 69.1 ± 12.8 years) with or without AAA, as shown in Table 1. Patients of each group (precisely BAV with or without AAA, TAV with or without AAA) were recruited from January 2015 to December 2016. The cases were randomly selected from patients referring to the Units of Cardiac Surgery (Department of Surgery and Oncology, University of Palermo) and Cardiology, for surgery replacement or routine care screening. Appropriate exclusion criteria were also used during the BAV/TAV enrollment, for the following diseases: (a) cardiovascular diseases were excluded according to history and by detecting apposite laboratory and imaging biomarkers as indicated by the latest ESC or ASC guidelines; (b) connective tissue disorders were excluded by assessing markers of inflammation immunological (i.e. autoantibodies) and imaging biomarkers; (c) inflammatory diseases (from infections to hematological, gastrointestinal, urogenital, pulmonary, neurological, endocrinal inflammatory disorders, and neoplasies included) by detecting apposite laboratory parameters (including complete blood cell count, erythrocyte sedimentation rate, glucose, urea nitrogen, creatinine, electrolytes, C reactive protein, liver function tests, iron, and proteins) and imaging biomarkers. In addition, all the enrolled cases belonged to the same ethnic group, since their parents and grandparents were born in Western Sicily. Thus, a very homogenous population was studied. Furthermore, elective or acute surgical treatment (using wheat operation, Bentall-De Bono and Tirone David surgical techniques, whenever possible) and complementary tubular-ascending aorta resection were performed in the BAV and TAV patients with AAA after evaluation of aortic transverse diameter sizes by Computed Tomography scanning according to recent guidelines, as reported in our review^{31 (link),33 (link)}. Accordingly, an experienced physician evaluated aortic transverse diameter sizes by echocardiography (Philips Ie. 33) before either elective or urgent surgery. The dimension of the aortic annulus, sinuses of Valsalva, proximal ascending aorta (above 2.5 cm of the sino-tubular junction) and aortic arch were assessed pre-operatively by trans-thoracic echocardiography as well as in the operating theatre by trans-oesophageal-echocardiography before the institution of the cardiopulmonary bypass. These measures, together with demographic and clinical data (including co-morbidities) were obtained from patients’ medical records and are presented in Table 1. In all BAV and TAV cases, hypertension was treated by beta-blockers.