In a retrospective review of 1286 patients with a BAV who underwent isolated AVR with a median of 12 years of follow-up, subsequent aortic dissection occurred in 1%, ascending aor- tic replacement surgery was needed in 0.9%, and progressive aortic enlargement was noted in In a smaller cohort of 153 patients with a BAV with prior AVR, 3% required proximal aor- tic surgery after 15 years of follow-up. No cases of aortic dissection were noted.7,10 These stud- ies demonstrate that the aorta may continue to dilate in patients with a BAV who undergo valve 5.1.2. Interventions for Patients With BAV 5.1.2.1. Intervention: Replacement of the Aorta Recommendations for Intervention: Replacement of the Aorta in Patients With a BAV Referenced studies that support the recommendations are summarized in Online Data Supplement 18. COR LOE Recommendations In asymptomatic or symptomatic patients with a BAV and a diameter of the aortic sinuses or ascending aorta >5.5 cm, operative intervention to replace the aortic sinuses and/ or the ascending aorta is recommended.1 3 In asymptomatic patients with a BAV, a diameter of the aortic sinuses or ascending aorta of 5.0 to 5.5 cm, and an additional risk factor for dissection (eg, family history of aortic dissection, aortic growth rate >0.5 cm per year, aortic coarctation), operative intervention to replace the aortic sinuses and/or the ascending aorta is reasonable if the surgery is performed at a Comprehensive Valve Center.3,4 Figure 5. Intervals for imaging the aorta in patients with a BAV. Colors correspond to Table 2. BAV indicates bicuspid aortic valve; CTA, computed tomographic angiography; CMR, cardiac magnetic resonance; TTE, transthoracic echocardiography. 