Background: A bicuspid aortic valve (BAV) is a common congenital cardiac anomaly, present in 1–2% of the adult population. In 25–40% of these patients, bicuspid aortopathy develops, characterized by dilation or aneurysm of the proximal aorta, requiring surgical treatment.

Aim: To evaluate the outcomes of surgical treatment for bicuspid aortic valve disease with different types of bicuspid aortopathy.

Materials and Methods: From July 2015 to July 2025, 144 patients with BAV disease complicated by proximal aortic dilation (PAD) underwent surgery. Reductive aortoplasty with xenopericardial patch exoprosthesis and concomitant aortic root/valve procedures (Group 1) were performed in 111 patients; Bentall-De Bono procedure in 31 patients (Group 2). Groups were comparable in demographic and clinical characteristics and in operative mortality risk (EvrosCORE II). Baseline proximal aorta dimensions were significantly larger in Group 2 (P = 0.03–0.001).

Results: CT angiography identified six patterns of proximal aortic dilation. Mean cardiopulmonary bypass (CPB) and aortic cross-clamp times were 158 ± 43 and 92 ± 22 minutes in Group 1, and 201 ± 33 and 126 ± 40 minutes in Group 2 (P = 0.001–0.007). Two-year mortality was observed in both groups; nonfatal complications were more frequent in Group 2. At discharge, there were no differences between groups in proximal aorta dimensions or functional status. In the long term, rates of aortic redilatation and survival were comparable between groups.

Mikhail Pavlov is an Saint-Petersburg- First State Medical University, Russian.