Commentary: Parley at the summit

Central MessageThis new nomenclature and classification system for patients with a bicuspid aortic valve aims high but its complexity may be challenging in clinical settings.See Article page e383. This settings. See Drawing from his fascination Mount Everest expeditions, Winston Churchill used the term summit to describe high-level meeting between international powers define world order 20th century. A distinguished list of coauthors, many whom are leaders (BAV) disease, commended their efforts provide us BAV.1Michelena H.I. Della Corte A. Evangelista Maleszewski J.J. Edwards W.D. Roman M.J. et al.International consensus statement on congenital aortopathy, clinical, surgical, interventional research purposes.J Thorac Cardiovasc Surg. 2021; 162: e383-e414Abstract Full Text PDF PubMed Scopus (29) Google Scholar The authors intend standardize language anatomy, diagnosis, treatment, data collection such patients, reflecting recently gained ground our evolving understanding this complex disease genetic, hemodynamic, standpoints. With prevalence 1%-2% general population,2Masri Svensson L.G. Griffin B.P. Desai M.Y. Contemporary natural history disease: systematic review.Heart. 2017; 103: 1323-1330Crossref (118) BAV is most common cardiovascular malformation seen relatively often by surgeons clinicians daily practice. Its heterogeneous presentation includes wide spectrum conditions, as pure stenosis, endocarditis, dissection, which lead regurgitation. Thus, practice management strategy among varies,3Verma S. Yanagawa B. Kalra Ruel M. Peterson M.D. Yamashita M.H. al.Knowledge, attitudes, patterns surgical aortopathy: survey 100 cardiac surgeons.J 2013; 146: 1033-1040.e4Abstract (74) even help available guidelines societies.4Borger M.A. Fedak P.W.M. Stephens E.H. Gleason T.G. Girdauskas E. Ikonomidis J.S. al.The American Association Thoracic Surgery valve-related full online-only version.J 2018; 156: e41-e74Abstract (149) Several important descriptive classifications have been published past, including those Sabet, Roberts, Angelini, Schaefer, Sievers.5Sievers H.H. Schmidtke C. 304 specimens.J 2007; 133: 1226-1233Abstract (806) Scholar, 6Angelini Ho S.Y. Anderson R.H. Devine W.A. Zuberbuhler J.R. Becker A.E. morphology normal compared having two leaflets.J 1989; 98: 362-367Abstract 7Roberts W.C. congenitally valve. study 85 autopsy cases.Am J Cardiol. 1970; 26: 72-83Abstract (736) 8Sabet H.Y. Tazelaar H.D. Daly R.C. Congenitally valves: pathology 542 cases (1991 through 1996) literature review 2,715 additional cases.Mayo Clin Proc. 1999; 74: 14-26Abstract (348) 9Schaefer B.M. Lewin M.B. Stout K.K. Gill Prueitt Byers P.H. valve: an integrated phenotypic leaflet root shape.Heart. 2008; 94: 1634-1638Crossref (351) Sievers commonly surgery collecting data, reporting outcomes, guiding therapy BAV. As we gain better conditions involved BAV, knowledge updated. Clearly, several points can extracted consensus.1Michelena We agree that within abnormal valves, unicuspid rare occurrence; condition typically presents younger (ie, than age 40 years), usually results mixed state stenosis regurgitation, include dilation annulus, or less frequently, ascending aorta.10Noly P.E. Basmadjian L. Bouhout I. Viet Le V.H. Poirier N. El-Hamamsy New insights into adults: not just subtype valves.Can 2016; 32: 110-116Abstract (32) such, should separate nomenclature. separation critically because, young patient population, choice repair replacement directly affects long-term prognosis. Additionally, suggested these esteemed integrates highlights points, namely establishing presence aortopathy role symmetry phenotype (such fused 2-sinus partly BAV). it determined whether any identified raphe calcified. These characteristics, especially era transcatheter replacement, where calcified, long, very asymmetric raphe, could associated increased risk complications mortality.11Yoon S.H. Kim W.K. Dhoble Milhorini Pio Babaliaros V. Jilaihawi H. al.Bicuspid outcomes after replacement.J Am Coll 2020; 76: 1018-1030Crossref (100) nomenclature1Michelena thoroughly comprehensive far more clinician use existing standards. time will tell how incorporated practice, care needed simplify key aspects conversations patients. Without doubt, work change way think about disease. An improved drive development appropriate therapy. Eventually, information formulate standard terminology, pertaining genetic markers coronary anomalies condition. There undeniable value unified method ease comparison techniques related across various institutions. integration emerging high-quality undoubtedly stimulate centers develop personalized International purposesThe Journal Cardiovascular SurgeryVol. 162Issue 3PreviewThis Consensus Classification Nomenclature recognizes 3 types 1. type (right-left cusp fusion, right-non-coronary fusion left-non-coronary phenotypes); 2. (latero-lateral antero-posterior 3. partial-fusion (forme fruste) type. phenotypes critical describe. also valve-associated Full-Text