However, the stroke rate at 30 days was higher in the BAV group.6 Other con- siderations are the younger age of patients with a BAV, for whom the risk benefit ratio of TAVI versus SAVR needs careful consideration. RCTs are needed to obtain full clarity on the optimal use of TAVI in this population, as well as long-term outcomes. 6. MITRAL STENOSIS The incidence of rheumatic MS is low in high-income countries and has been slowly declining in low- and mid- dle-income countries, but MS remains a major cause of valve disease worldwide. Rheumatic MS is much more common in women (about 80% of cases) than in men. The clinical presentation of rheumatic MS varies, with patients from regions with a high disease prevalence presenting at a young age (teen years to age 30 years) Figure 6. Intervention for replacement of the aorta in patients with a BAV. Colors correspond to Table 2. *Family history of aortic dissection, aortic growth rate 0.5 cm/y, and/or presence of aortic coarctation. BAV indicates bicuspid aortic valve; AVR, aortic valve re- placement; and CVC, Comprehensive Valve Center. CLINICAL STATEMENTS AND GUIDELINES with commissural fusion but pliable noncalcified valve leaflets. In contrast, the presentation in regions with a low disease prevalence occurs more often in older pa- tients (age 50 to 70 years) who present decades after the initial rheumatic fever episode with calcified fibrotic leaf- lets in addition to commissural fusion and subvalvular involvement. 