OBJECTIVES: Endoscopic surgery has emerged as an evolution of minimally invasive approaches, but evidence regarding its application in combined valve procedures remains scarce. This study evaluates its feasibility and mi...OBJECTIVES: Endoscopic surgery has emerged as an evolution of minimally invasive approaches, but evidence regarding its application in combined valve procedures remains scarce. This study evaluates its feasibility and mid-term outcomes in concomitant aortic and mitral valve (MV) surgery. METHODS: We retrospectively analysed all consecutive patients undergoing endoscopic concomitant mitral and aortic valve (AV) surgery from January 2016 to July 2025. Cardiopulmonary bypass (CPB) was established via peripheral cannulation. All procedures were performed through a right mini-thoracotomy using a 30° thoracoscope. The primary end-point was in-hospital mortality. Secondary end-points included major postoperative complications, a composite early outcome (in-hospital mortality, stroke, major bleeding requiring revision, postoperative myocardial infarction, or dialysis), and mid-term survival. Univariable logistic regression was used to identify predictors of the composite early postoperative outcome. Follow-up was 100% complete. RESULTS: The analysis included 111 patients (median age 70 years [interquartile range, IQR 62-76], 55 males, median EuroSCORE II 3.3 [IQR 1.90-5.04]). The AV was replaced in all cases. Mitral valve was repaired in 54 cases and replaced in 57. Concomitant procedures were performed in 44 cases. Median CPB and cross-clamp times were 198 [164-233] and 139 [117-160] minutes, respectively. In-hospital mortality was 3.6%, with low rates of stroke (3.6%), bleeding (8.1%), and dialysis (5.4%). At a median follow-up of 46 months, overall survival was 87%. Reduced estimated glomerular filtration rate (eGFR), coronary artery disease, chronic lung disease, and peripheral arteriopathy were significantly associated with the composite early outcome. CONCLUSIONS: Endoscopic technique can be successfully applied to combined aortic and MV surgery, encouraging its broader adoption. IRB NUMBER: 2020189, July 30, 2020.
OBJECTIVES: Chronic lung allograft dysfunction (CLAD) is a major factor limiting long-term survival after heart-lung transplantation (HLTx). Whether lung retransplantation (LRTx) offers the same long-term results in HLTx...OBJECTIVES: Chronic lung allograft dysfunction (CLAD) is a major factor limiting long-term survival after heart-lung transplantation (HLTx). Whether lung retransplantation (LRTx) offers the same long-term results in HLTx recipients as in double-lung transplantation (DLTx) recipients remains unknown. The aim of this study was to compare outcomes of LRTx after HLTx and DLTx. METHODS: We retrospectively reviewed charts of patients retransplanted at our institution in 2006-2023. Outcomes after LRTx, overall survival, and bronchiolitis obliterans syndrome (BOS)-free survival were compared between HLTx and DLTx groups. RESULTS: LRTx was performed in 60 patients, including 20 after HLTx and 40 after DLTx. Median post-retransplant follow-up was 3.54 years [1.37-6.79]. Median time to retransplantation was significantly shorter in LRTx group (HLTx: 5.47 [4.55-7.02] years vs DLTx: 2.77 [1.55-5.46] years; P = .03). Overall in-hospital mortality was 5% (n = 3) with no significant difference between the groups. The 2 groups were similar for primary graft dysfunction (PGD) Grade 2 or 3 at 72 hours (HLTx: 17%; DLTx: 39%; P = .133), 1- and 5-year overall survival (HLTx: 70% and 54%; DLTx: 87% and 43%; P = .249) and 1- and 5-year BOS-free survival rates (HLTx: 70% and 40%; DLTx: 72% and 33%; P = .402). With LRTx after HLTx, 10-year freedom from cardiac allograft vasculopathy (CAV) since the first transplant was 72%. CONCLUSIONS: Overall survival and BOS-free survival benefits of LRTx were similar after DLTx or HLTx. LRTx in HLTx group did not lead to an increased risk of CAV. LRTx seems a good option for carefully selected patients with end-stage CLAD after HLTx to improve survival and quality of life.
OBJECTIVES: Neonates and infants who receive a Ross or Ross-Konno operation form a different population from older children and adults who undergo this procedure. We aimed to provide a contemporary reassessment of the pr...OBJECTIVES: Neonates and infants who receive a Ross or Ross-Konno operation form a different population from older children and adults who undergo this procedure. We aimed to provide a contemporary reassessment of the procedure in patients younger than 1 year of age. METHODS: We conducted a retrospective, observational multicentre study of patients younger than 1 year who underwent a Ross procedure. Clinical data were obtained from hospital records. Survival was analysed with Kaplan-Meier analysis and Cox regression, and reinterventions with competing-risk models. RESULTS: Eighty-one children underwent a Ross procedure at a median age of 96 days (IQR 38-166) and a median weight of 4.5 kg (IQR 3.4-6.3), with a median follow-up of 3.8 years (IQR 0.6-10) with a maximum follow-up of 18.6 years. There were 23 (28.4%) deaths, with 15 (18%) occurring in-hospital. Ten-year survival was 72.7%. Longer cardiopulmonary bypass times and extracorporeal membrane oxygenation (ECMO) requirement were associated with in-hospital mortality, while younger age showed a borderline association (P = .05). At 10 years, the cumulative incidence of reintervention was 72.6%, mostly due to a high rate of right ventricle to pulmonary artery (RVPA) conduit reintervention (52.2% at 10 years), but with a low pulmonary autograft reintervention rate (7.6% at 10 years). CONCLUSIONS: Outcomes of Ross (-Konno) operations in patients younger than 1 year reflect the high complexity of this population. Early mortality is significant with acceptable long-term survival rates. The pulmonary autograft in aortic position has good durability with few reinterventions, while RVPA conduits have demonstrated a high number of reinterventions.
Onorati I, Radu DM, Maiolino E
… +13 more, Suriano I, Juvin C, Peretti M, Portela AM, Bardet J, Venissac N, Mouhamed M, Freynet O, Lebreton G, Beloucif S, Uzunhan Y, Huet O, Martinod E
OBJECTIVES: In complex airway surgery and high-risk rigid bronchoscopy, conventional ventilation may be unsafe or impossible. We report our experience using veno-venous extracorporeal membrane oxygenation (VV-ECMO) as re...OBJECTIVES: In complex airway surgery and high-risk rigid bronchoscopy, conventional ventilation may be unsafe or impossible. We report our experience using veno-venous extracorporeal membrane oxygenation (VV-ECMO) as respiratory support. METHODS: We retrospectively reviewed patients managed with planned VV-ECMO for airway surgery or high-risk rigid bronchoscopy (May 2012 to February 2025). Indications were anticipated inability to ventilate due to extensive lesions or a high risk of major bleeding. Data included patients' and procedures' details, ECMO configuration, and 30-day outcomes. RESULTS: Twenty-four patients (15 women, 9 men; mean age 49 years, range 20-66) underwent 28 procedures under VV-ECMO: 11 rigid bronchoscopies and 17 surgeries, including 15 airway replacements with a stented cryopreserved aortic allograft, 1 tracheal repair after injury, and 1 tracheal resection with end-to-end anastomosis. Cannulation was mainly femoro-jugular (93%). Decannulation occurred in the operating theatre in 22 cases after a mean run of 3.8 h; it was delayed 1-22 days in 4 cases, and 2 patients died while still on ECMO. Major 30-day morbidity occurred in 10 patients and minor in 13; ECMO-specific complications occurred in 4 cases (deep-vein thrombosis, n = 3; vasoplegic syndrome, n = 1), all resolving medically. Thirty-day mortality was 5/24 patients (21%): 3 surgical and 2 endoscopic. In 2 deaths, a contribution of VV-ECMO could not be excluded. At the last follow-up, 16 patients were alive. CONCLUSIONS: Planned VV-ECMO may be considered a useful adjunct for complex airway surgery and high-risk rigid bronchoscopy when ventilation is precarious or major bleeding is anticipated, enabling safer, more controlled interventions in selected patients.
OBJECTIVES: Congenital aortic valve (AoV) disease has limited treatment options in growing children. Different initial strategies, AoV repair/surgical valvuloplasty (SAV), AoV replacement (AVR), and Ross procedure were c...OBJECTIVES: Congenital aortic valve (AoV) disease has limited treatment options in growing children. Different initial strategies, AoV repair/surgical valvuloplasty (SAV), AoV replacement (AVR), and Ross procedure were compared to elucidate the current best strategy. METHODS: All paediatric patients undergoing different initial AoV surgeries from 1976 to 2024 were included. Factors including prior balloon dilation (balloon valvuloplasty [BAV]), valve morphology, and initial disease (stenosis/regurgitation/mixed) were analysed. Survival and incidence of AoV reoperation/≥moderate AoV insufficiency/stenosis were evaluated. RESULTS: A total of 323 patients underwent 142 SAV/33 AVR/137 Ross at median age/weight of 5.7 years [interquartile range, 0.5-12.6]/19.9 kg [6.9-48.8]. Surgical valvuloplasty group was the youngest (P < .01). Thirty-day mortality was 2.5% (8/323) without group differences (P = .15). Median follow-up was 9.6 years [2.7-17.8] with 10-/20-year survival rates of 90.4% [86.1-93.4]/87.1% [81.4-91.1] without group differences. Twenty-year cumulative incidences of AoV reoperations were higher after SAV: 78.4% [70.8-86.9] vs 24.6% [11.7-51.7] after AVR and 15% [6.8-33.1] after Ross, P < .01. Survivors with their native AoV at 20 years (n = 48, 14.8%) were younger at initial surgery (P < .01), had predominantly AoV stenosis (91.7%), and had fewer BAVs (P < .01). Cox regression demonstrated 7.8-fold higher mortality hazard after AVR (P < .01) and a lower reoperation hazard after AVR and Ross (HR 0.1 [95% CI, 0.1-0.5], P < .01 and HR 0.1 [95% CI, 0.1-0.3], P < .01) compared to SAV. CONCLUSIONS: All initial AoV surgeries brought excellent early/long-term survival. Aortic valve reoperations occur most frequently after SAV. In case of favourable AoV anatomy, early SAV can preserve the native valve. Ross procedure identified as safe and durable.
OBJECTIVES: The purpose of this study was to systematically evaluate predictive models for assessing the risk of postoperative recurrence in patients with early-stage non-small cell lung cancer, and to determine the effe...OBJECTIVES: The purpose of this study was to systematically evaluate predictive models for assessing the risk of postoperative recurrence in patients with early-stage non-small cell lung cancer, and to determine the effect of integrating different data modalities on model performance. METHODS: A systematic search of PubMed, Embase, and Web of Science databases up to April 30, 2025 identified eligible studies. Seventeen original studies were included after screening 2672 records and reviewing 133 full texts. Data extraction focused on study characteristics, types of data used, modelling strategies, and predictive performance. Risk of bias was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST)+artificial intelligence (AI) tool. RESULTS: Random forest and random survival forest models performed robustly on single-modality data, while the integration of multimodality data significantly improved model performance (area under the curve [AUC] range: 0.72-0.94). Notably, the DeepRePath model based on XGBoost achieved an AUC of 0.94 in pathological image analysis, while graph neural networks also performed well in multicentre CT data analysis (AUC 0.785). However, models generally face the risk of overfitting. PROBAST+AI tool assessments revealed that 7 studies were classified as high-risk during the model development phase due to improper sample handling, while 13 studies exhibited high bias risk during the validation phase due to insufficient test set size (<100) or reliance on apparent performance. CONCLUSIONS: Predictive models show promising accuracy for recurrence risk assessment in early-stage non-small cell lung cancer, with multimodal data integration improving generalizability. PROSPERO: CRD42024629196.
OBJECTIVES: To investigate how recurrence patterns in oesophageal squamous cell carcinoma (ESCC) are influenced by primary tumour location, treatment modality, and pathologic stage, and distinguish true recurrence from f...OBJECTIVES: To investigate how recurrence patterns in oesophageal squamous cell carcinoma (ESCC) are influenced by primary tumour location, treatment modality, and pathologic stage, and distinguish true recurrence from frequent secondary primary malignancies. METHODS: A total of 953 ESCC patients (mean age, 62.6 ± 7.7 years, 883 [92.7%] male) who underwent curative-intent oesophagectomy between 2010 and 2020 were retrospectively analysed. Patients were categorized by tumour location (upper/mid vs lower), pathologic stage (0-I vs II-IV), and treatment modality (upfront surgery vs neoadjuvant chemoradiation). Recurrence patterns were classified as loco-regional, distant, or mixed. Secondary primary malignancies were also documented. Associations between recurrence patterns and post-recurrence survival (PRS) were assessed using multivariable Cox regression. RESULTS: Recurrence occurred in 23.4% (223/953) of patients, mostly within 2 years post-surgery (83.4%). Among early pathologic stage (0-I) patients treated with upfront surgery, upper/mid oesophageal cancers had a higher rate of loco-regional recurrence compared with lower oesophageal cancers (16.3% vs 6.7%; P = .003), particularly in the mediastinal (10.9% vs 4.8%) and supraclavicular lymph nodes (6.3% vs 1.4%). No location-related differences were observed in advanced pathologic stage (II-IV) or neoadjuvant chemoradiation groups. Distant recurrence predominated in the neoadjuvant chemotherapy group (19.6% vs 9.7%). The lung was the most frequent site of distant metastasis (7.6%-8.6%), presenting as solitary nodules (24/45). Secondary lung cancers occurred later than pulmonary recurrences (median 58.3 vs 6.9 months; P < .001). Mixed recurrence was associated with worse PRS (adjusted hazard ratio, 1.77; 95% confidence interval, 1.18-2.66; P = .006). CONCLUSIONS: ESCC recurrence patterns vary by tumour location, treatment modality, and pathologic stage. The lung is the most common site of distant recurrence and presents earlier than secondary lung cancer.
Yanagihara T, Miura K, Bernards N
… +18 more, Kitazawa S, Yokote F, Nakahashi K, Fujibayashi Y, Hinokuma H, Sonoda D, Hayama N, Wakeam E, Donahoe L, Yeung J, Cypel M, De Perrot M, Pierre A, Waddell T, Keshavjee S, Cabanero M, Sato Y, Yasufuku K
OBJECTIVES: Adequate surgical margin is essential when performing a sublobar resection. We have previously demonstrated the feasibility of surgical margin evaluation on resected lung specimens using computed tomography (...OBJECTIVES: Adequate surgical margin is essential when performing a sublobar resection. We have previously demonstrated the feasibility of surgical margin evaluation on resected lung specimens using computed tomography (CT). We aim to evaluate the reliability and impact of intraoperative CT image feedback for surgical decision-making. METHODS: Patients scheduled for therapeutic wedge resections for lung malignancies were enrolled. The wedge-resected specimen was inflated with air and scanned by CT. The CT images were shared with the attending surgeons to determine whether additional management was required. The surgeon's estimated margins (estiMargins) were also surveyed before and after resection. RESULTS: Seventy specimens (27 lung cancers and 43 metastatic lung tumours, including suspected cases) from 61 patients underwent CT. Computed tomography-measured margins were successfully evaluated except in 4 cases due to poor tumour identification. Computed tomography-measured margins closely agreed with pathological margins (pathMargins), as indicated by Bland-Altman analysis (bias 0.6 mm, limits of agreement -8.1 to 9.4 mm). A strong correlation between them was observed using Pearson's correlation analysis (r = 0.75). Pre- and post-resection estiMargin were significantly longer than pathMargin (11.0 ± 5.0 vs 11.5 ± 7.0 vs 8.3 ± 6.5 mm, P < .01). The reference CT images impacted the surgical decision-making in 7.4% of lung cancer cases (1 case: additional cytology; 2 cases: considered additional resection). CONCLUSIONS: CT-based margin evaluation method can provide an intraoperative timely and more reliable estimate of the pathMargin compared to surgeon's estimates and could be a novel approach to ensure more sufficient surgical margins during wedge resection. CLINICAL REGISTRATION NUMBER: NCT07242053.
OBJECTIVES: Root computed tomography angiography is a helpful imaging tool for designing aortic valve repair and valve-sparing surgery. It remains unclear whether this method produces reliable measurements in virtual bas...OBJECTIVES: Root computed tomography angiography is a helpful imaging tool for designing aortic valve repair and valve-sparing surgery. It remains unclear whether this method produces reliable measurements in virtual basal ring and geometric height. We aimed to evaluate the accuracy in a large patients' sample. METHODS: The virtual basal ring and geometric height were evaluated by computed tomography and intraoperative measurements, with the virtual basal ring additionally assessed by transthoracic echocardiography (TTE). The consistency was evaluated with the Bland-Altman method. RESULTS: A total of 238 patients with good quality image data were included. The virtual basal ring was 26.42(4.23) mm on TTE, 28.83(4.50) mm on root computed tomography angiography, and 28.06(4.00) mm on intraoperatively(ICC: 0.96 versus 0.98). The geometric height of the left tricuspid cusp, left bicuspid cusp in 2 sinuses, and non-fused bicuspid cusp with right non-fusion was 19.28(2.24) mm on computed tomography versus 19.24(2.20) mm intraoperatively (ICC = 0.97). The geometric height of the right tricuspid cusp and the right bicuspid cusp with 2 sinuses was 19.06(2.41) mm vs 19.11(2.50) mm (ICC = 0.97). The geometric height of the non-coronary tricuspid cusp and the non-fused bicuspid cusp with left-right fusion was 20.54(2.63) mm vs 20.84(2.77) mm (ICC = 0.98). CONCLUSIONS: The virtual basal ring and geometric height can be accurately measured using root computed tomography angiography. For patients potentially eligible for aortic valve repair and valve-sparing aortic root replacement, it may provide important information to plan the surgical strategy.
OBJECTIVES: Cerebral malperfusion in acute type A aortic dissection (ATAAD) is a serious condition. Predicting postoperative neurological outcomes is important to decide treatment strategies; however, current prediction...OBJECTIVES: Cerebral malperfusion in acute type A aortic dissection (ATAAD) is a serious condition. Predicting postoperative neurological outcomes is important to decide treatment strategies; however, current prediction methods have limitations. Therefore, this study examined whether the lateral ventricular volume ratio (LVR) on preoperative head computed tomography (CT) can predict postoperative neurological outcomes. METHODS: Among patients who underwent surgery for ATAAD at our institution between January 2007 and August 2024, those with cerebral malperfusion who underwent preoperative head CT were included. Cerebral malperfusion was defined as common carotid artery true lumen stenosis ≥50% and new neurological symptoms. The LVR was calculated as the larger lateral ventricular volume divided by the smaller lateral ventricular volume. RESULTS: Of 386 patients with ATAAD, 33 had cerebral malperfusion and underwent preoperative CT. Receiver operating characteristic analysis determined LVR < 1.067 as the cut-off, classifying patients into the symmetric group (ratio < 1.067, n = 10) or the asymmetric group (ratio ≥ 1.067, n = 23). The symmetric group showed 80% postoperative neurological recovery compared with 26% in the asymmetric group (P = .007). The postoperative modified Rankin Scale score was ≥4 in 20% and 78% of patients in the symmetric and asymmetric groups, respectively (P = .005). Univariable analysis identified lateral ventricular symmetry as a predictor of postoperative neurological recovery (odds ratio = 11.3, 95% confidence interval: 1.86-69.1, P = .008). Long-term overall survival was significantly better in the symmetric group than in the asymmetric group (P = .043). CONCLUSIONS: In patients with ATAAD and cerebral malperfusion, lateral ventricular symmetry on preoperative head CT may predict postoperative neurological outcomes. CLINICAL REGISTRATION NUMBER: 4707.
OBJECTIVES: We developed a radiofrequency identification (RFID) marking system to improve localization of small, deeply situated pulmonary lesions during thoracoscopic surgery. This study was conducted to evaluate RFID m...OBJECTIVES: We developed a radiofrequency identification (RFID) marking system to improve localization of small, deeply situated pulmonary lesions during thoracoscopic surgery. This study was conducted to evaluate RFID marking efficacy with reference to indocyanine green (ICG)-virtual-assisted lung mapping (VAL-MAP). METHODS: We retrospectively compared clinical outcomes of wedge resections using RFID (prospectively collected) and ICG-VAL-MAP (historical cohort, January 2017 to December 2024). The primary outcome of successful resection without additional resection was assessed by multivariate logistic regression with Firth's penalized likelihood correction. RESULTS: Among the 101 lesions (RFID: 45; ICG-VAL-MAP: 56), lesions with RFID were smaller (0.97 ± 0.45 vs 1.19 ± 0.57 cm) and had greater pleural depth (1.21 ± 0.85 vs 0.81 ± 0.70 cm). The RFID procedure time was longer (42 vs 34 minutes), with a computed tomography marker-to-lesion distance of 0.66 ± 0.61 cm. One mild pneumothorax occurred with ICG-VAL-MAP. Radiofrequency identification reduced intraoperative palpation (11/45 vs 37/56) and achieved a higher primary success rate (100% vs 95%). Multivariate analysis showed reduced postoperative complications with RFID (adjusted odds ratio [OR] 0.33, 95% confidence interval 0.07-1.24). CONCLUSIONS: RFID marking achieved 100% successful resection for small/deep lesions and reduced palpation needs and complications (adjusted OR 0.33), outperforming the ICG-VAL-MAP historical reference (95%). However, the retrospective design, selection bias, and limited power warrant cautious, exploratory interpretation, and prospective validation is needed.
Sarikouch S, Boethig D, Avsar M
… +11 more, Ciubotaru A, Cheptanaru E, Cazacu A, Beerbaum P, Westhoff-Bleck M, Cebotari S, Tudorache I, Cvitkovic T, Bobylev D, Ruhparwar A, Horke A
Eur J Cardiothorac Surg
· 2026 Feb · PMID 41652890
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OBJECTIVES: Fresh, non-cryopreserved and non-seeded, decellularized pulmonary homografts (DPHs) were translated in 2005 into clinical practice. The aim of this current study is to summarize our 20-year clinical experienc...OBJECTIVES: Fresh, non-cryopreserved and non-seeded, decellularized pulmonary homografts (DPHs) were translated in 2005 into clinical practice. The aim of this current study is to summarize our 20-year clinical experience with DPH for pulmonary valve replacement (PVR) in congenital heart disease. METHODS: Prospective follow-up of all DPH implanted within 2 institutions. Indication for PVR according to current clinical guidelines was the key inclusion criterion without age limits; patients with active endocarditis were not included. RESULTS: From January 2005 to August 2025, 310 patients (188 male) received DPH for PVR. Median patient age at implantation was 14.8 years, (interquartile range [IQR] 12.7-16.6 years, min. 0.1 years, max.72.8 years), and the median DPH diameter was 22 mm (IQR 19-23 mm, min. 12 mm, max 34 mm). Median follow-up was 8.3 years (IQR 4.5-12.1, max 20.5 years). Seven out of 310 patients died, a freedom from death according Kaplan-Meier of 96.9% (confidence interval [CI] 93.1%-98.6%) at 20 years. Freedom from DPH explantation was 85.2% (CI 75.1%-91.4%), and freedom from endocarditis was 91.0% (CI 77.1%-96.6%) at 20 years. Valve function showed a steady decline over the study period. At 15 years, freedom from stenosis, as defined as a maximum gradient of ≥ 50 mmHg, was 68.3% (CI 52.4%-79.8%) and 0 at 20 years. Freedom from ≥ moderate pulmonary regurgitation was 65.1% (CI 48.1%-77.7%) at 15 years and 0 at 20 years. The number of patients at risk beyond 15 years was limited. CONCLUSIONS: Decellularized pulmonary homografts show good long-term results for PVR with freedom from explantation that appears favourable compared with published long-term series of cryopreserved homografts. However, our data also indicate a decline in valve function over 2 decades. We hypothesize that residual immunogenicity is the underlying cause, suggesting that there is potential for further refinement of decellularization methods.
OBJECTIVES: To develop and internally validate a novel scoring system for bicuspid aortic valve (BAV) reparability based on routinely collected transoesophageal echocardiography (TEE) parameters. METHODS: We conducted a...OBJECTIVES: To develop and internally validate a novel scoring system for bicuspid aortic valve (BAV) reparability based on routinely collected transoesophageal echocardiography (TEE) parameters. METHODS: We conducted a retrospective analysis of 203 consecutive BAV patients who underwent surgery for aortic regurgitation between 2018 and 2024. Ten preoperative TEE parameters associated with valve repair were systematically analysed; significant variables were included in a multivariate analysis and then integrated into a scoring system. RESULTS: Four baseline TEE measurements emerged as independent parameters associated with BAV repair: geometric height ≥ 18 mm (odds ratio [OR]: 8.05; 95% confidence interval (CI): 3.15 to 22.94; P ≤ .001), commissural orientation ≥ 140° (OR: 8.29; 95% CI: 2.67-25.67; P ≤ .001), good cusp quality (OR: 20.4; 95% CI: 6.59-63.53; P ≤ .001), and preserved cusp mobility (OR: 11.1; 95% CI: 3.98-31.45; P ≤ .001). We integrated these findings into the simple, 9-point HOME score. The score demonstrated excellent discrimination for successful repair (area under the curve = 0.89, 95% CI: 0.79-0.94), effectively stratifying patients into groups with low (score 0-4), intermediate (5-6), and high (7-9) likelihoods of a valve-preserving surgery. CONCLUSIONS: The HOME score may help identify BAV patients with a high probability of preserving surgery in a more standardized and reliable way.