An Innovative Echocardiographic Scoring System for Bicuspid Aortic Valve Repair

Objectives: To develop and internally validate a novel scoring system for bicuspid aortic valve (BAV) reparability based on routinely collected transoesophageal 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 analysed; 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 ≤.001), commissural orientation≥140° (OR: 8.29; 95% CI: 2.67-25.67; P ≤.001), good cusp quality (OR: 20.4; 95% CI: 6.59-63.53; P ≤.001), and preserved cusp mobility (OR: 11.1; 95% CI: 3.98-31.45; P ≤.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.