The Sievers Classification of the Bicuspid Aortic Valve for the Perioperative Echocardiographer: The Importance of Valve Phenotype for Aortic Valve Repair in the Era of the Functional Aortic Annulus

A BICUSPID AORTIC VALVE (BAV) is composed of 2 functional cusps, also called valve leaflets. The BAV is a common congenital cardiac anomaly, with an estimated incidence of 1% to 2% in the general population. 1 Augoustides J.G. Wolfe Y. Walsh E.K. et al. Recent advances in aortic valve disease: Highlights from a bicuspid valve to transcatheter aortic valve replacement. J Cardiothorac Vasc Anesth. 2009; 23: 569-575 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar , 2 Ward C. Clinical significance of the bicuspid aortic valve. Heart. 2000; 83: 81-85 Crossref PubMed Scopus (597) Google Scholar Given this high incidence and the propensity for the BAV to present with surgical aortic valve disease in in the third to fifth decades of life, the BAV remains relevant and important for the perioperative echocardiographer. 3 Augoustides J.G.T. Szeto W.Y. Bavaria J.E. Advances in aortic valve repair: Focus on functional approach, clinical outcomes and central role of echocardiography. J Cardiothorac Vasc Anesth. 2010; 24: 1016-1020 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar , 4 Prodromo J. D’Anconna G. Arnaducci A. et al. Aortic valve repair for aortic insufficiency: A review. J Cardiothorac Vasc Anesth. 2012; 26: 923-932 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar The maturation of aortic valve repair in the current era has included the development of a systematic approach to the BAV phenotype as a platform for describing and planning BAV repair. 4 Prodromo J. D’Anconna G. Arnaducci A. et al. Aortic valve repair for aortic insufficiency: A review. J Cardiothorac Vasc Anesth. 2012; 26: 923-932 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 5 Korniva T. Aortic valve repair update. Gen Thorac Cardiovasc Surg. 2015; 63: 309-319 Crossref PubMed Scopus (22) Google Scholar , 6 Vohra H.A. Whistance R.N. De Kerchove L. et al. Valve-preserving surgery on the bicuspid aortic valve. Eur J Cardiothorac Surg. 2013; 43: 888-898 Crossref PubMed Scopus (36) Google Scholar This review focuses on the classification of the BAV phenotype and its relevance in aortic valve repair for the perioperative echocardiographer. 7 Della Corte A. Body S.C. Booher A.M. et al. Surgical treatment of bicuspid aortic valve disease: Knowledge gaps and research perspectives. J Thorac Cardiovasc Surg. 2014; 147: 1749-1757 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar , 8 Michelena H. Prakash S.K. Della Corte A. et al. Bicuspid aortic valve: Identifying knowledge gaps and rising to the challenge from the International Bicuspid Aortic Valve Consortium (BAVCon). Circulation. 2014; 129: 2691-2704 Crossref PubMed Scopus (277) Google Scholar