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An Innovative Echocardiographic Scoring System for Bicuspid Aortic Valve Repair.

Gianpiero Italiano1, Martina Belli1, Giulio Folino2

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|February 6, 2026
PubMed
Summary

A new HOME score predicts bicuspid aortic valve repair success using transesophageal echocardiography. This simple tool helps surgeons identify patients likely to benefit from valve-preserving surgery.

Keywords:
aortic regurgitationaortic valve repairbicuspid aortic valvecardiac surgeryechocardiography

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Bicuspid aortic valve (BAV) disease is a common congenital heart defect.
  • Assessing BAV reparability preoperatively is crucial for surgical planning.
  • Current methods for predicting BAV repair outcomes can be variable.

Purpose of the Study:

  • To develop and validate a novel scoring system for bicuspid aortic valve (BAV) reparability.
  • To utilize routinely collected transesophageal echocardiography (TEE) parameters for this scoring system.
  • To aid in decision-making for valve-preserving surgery in BAV patients.

Main Methods:

  • Retrospective analysis of 203 BAV patients undergoing aortic regurgitation surgery (2018-2024).
  • Systematic analysis of ten preoperative TEE parameters associated with valve repair.
  • Multivariate analysis to identify significant predictors, integrated into the HOME score.

Main Results:

  • Four independent TEE parameters predicted BAV repair: geometric height ≥18mm, commissural orientation ≥140°, good cusp quality, and preserved cusp mobility.
  • The developed 9-point HOME score demonstrated excellent discrimination for successful repair (AUC=0.89).
  • The HOME score effectively stratified patients into low, intermediate, and high likelihoods of successful valve-preserving surgery.

Conclusions:

  • The HOME score provides a standardized and reliable method for assessing BAV reparability.
  • This scoring system can assist surgeons in identifying BAV patients suitable for valve-preserving procedures.
  • Improved preoperative assessment may lead to better surgical outcomes for BAV patients.