See the respective sec- tions on AS (Section 3.2) and AR (Section 4). The choice of prosthetic valve type in patients with a BAV is similar to that for patients with trileaflet valves. See the sec- tion on prosthetic valve choices (Section 3.2.4.1) for full details. Given the unique nature of BAV, however, there are additional specific considerations. Recommendations for Intervention: Replacement of the Aorta in Patients With a BAV (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Recommendation-Specific Supportive Text 1. Surgical repair of the aortic valve may be feasible in selected patients, depending on valve and aortic root anatomy and tissue characteristics. Published data suggest that valve repair can be performed safely and effectively by surgeons with training and experience in these techniques.1 3,7 However, given the complexities of patient selection and surgical techniques, such surgeries should be per- formed at a Comprehensive Valve Center. 2. Recent trials have demonstrated the benefits of TAVI in patients with severe, symptomatic AS. However, the early pivotal TAVI trials excluded patients with BAV. Initial studies using early-gener- ation valves suggested a higher rate of paravalvular leak in the BAV population.4,5 Data from the STS/ ACC Transcatheter Valve Therapies Registry, which includes all consecutive TAVI procedures performed in the United States, suggest that with the use of newer-generation prosthetic valves the rate of paravalvular leak is no different in patients with a BAV than in patients with a trileaflet aortic valve. This registry also showed no difference in mortality rate at 30 days and 1 year between the BAV and tricuspid valve groups. 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. 