There is wide heterogeneity of timing of surgical referral, which makes interpretation of longitu- dinal studies problematic. BAV is the most common CHD, is associated with aortopathy, and is of high concern for aortic complica- tions, as discussed in other guideline statements.S4.2.4.2-1 Although in many published series of aortic dis- section, BAV patients account for a higher proportion of dissections than expected from prevalence of BAV CLINICAL STATEMENTS AND GUIDELINES in the general population alone, the risk of dissection or rupture amongst all BAV patients is less clear. The largest population study reported a 0.5% risk of aortic rupture or dissection after a mean of 16 years of follow- although 11% underwent elective aortic sur- gery. Risk factors for aortic complications were age and an enlarged aorta at baseline. Frequency of dissection in BAV disease is higher in adults with Turner syndrome. A dilated neoaortic root after a Ross procedure is not uncommon, although only a single dissection has been Because of this, it is generally believed that prophylactic root replacement strategies based on sinus of Valsalva diameters can be less aggressive after a Ross procedure than in a native BAV patient, but practice patterns vary. Most patients with a Ross repair had under- lying congenitally abnormal aortic valves (BAV or unicus- pid aortic valve) and, therefore, are at risk of the ascend- ing aortic dilation typical of those abnormalities. Thus, in addition to the dilation at the sinuses of Valsalva associ- ated with the Ross repair, dilation of the native ascending aorta above the sinotubular junction can also occur. 