In search of the right study design for bicuspid aortopathy treatment.

Dr Vendramin: Surprisingly, we have a low incidence of reoperation, but we used a lot of mechanical valves, so we have no problems with that. And we started to use biological valves in these young patients just in the last year, so we haven’t yet seen the deterioration of the bioprosthesis. We had two reoperations, one in the SAAR group and one in the Bentall group, for infection of the prosthesis. So both cases are challenging procedures, but in the case of the SAAR group, a separate valve and ascending aorta replacement is a less challenging procedure, for sure. If you have to reoperate on a patient with a Bentall procedure, you have to change everything and the reoperation will be really more and more challenging. Dr Menicanti: The last question, according to these results, which are outstanding, a very low incidence of reintervention, great survival, for which patient do you think the Ross procedure can be applied? Dr Vendramin: I think that the age of the patient is a determinant and secondly every alteration of the morphology of the root. Asymmetry of the root and wall thickness I think could be a predominant element to choose a different kind of procedure.