Objective Determine whether associations between bicuspid aortic valve (BAV) phenotypes, valve disease and aortopathy differ between sexes. Methods 1045 patients with BAV (76.0% men, n=794) from two surgical centres were included in this cross-sectional study. Valve phenotype was classified intraoperatively as right–left (RL), right-non-coronary (RN), left-non-coronary (LN) or 2-sinus BAV. Echocardiography was used to determine type and degree of valve disease, and aortic dimensions. Aortic dilatation was defined as diameter ≥4.5 cm. Results RL was the most common phenotype (73.6%), followed by RN (16.2%), 2-sinus BAV (9.2%) and LN (1.1%), with no difference in phenotype distribution between men and women (p=0.634). Aortic valve insufficiency (AI) prevalence differed significantly with valve phenotype in men (p=0.047), with RL and LN having the highest prevalence (34.1% and 44.0%, respectively). In women, RN had a higher proportion of AI than RL (21.3% vs 7.3%, p=0.017). Men with RL had larger root dimensions, in particular at the sinus (mean difference 0.24 cm compared with RN, p=0.002). Men with 2-sinus BAV had the highest prevalence of root phenotype dilatation (7.0%, other phenotypes ≤2.3%, p=0.031), whereas women with 2-sinus BAV did not have root dilatation and smaller sinus dimensions (mean difference: 0.35 cm compared with RL, p=0.021). Aortic root segments were larger in men with AI compared with aortic stenosis (sinus mean difference: 0.40 cm, p<0.001). The difference was even larger in women (mean difference: 0.78 cm, p<0.001), and women with AI also had larger tubular segments (mean difference: 0.61 cm, p=0.001). Conclusions There are significant sex differences in clinical associations of BAV phenotypes, which should be considered in further studies on the role of phenotypes in individualised patient management. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data.

中文翻译：

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二尖瓣主动脉瓣表型的瓣膜疾病和主动脉病变关联在男性和女性之间存在差异

目的 确定二尖瓣主动脉瓣 (BAV) 表型、瓣膜疾病和主动脉病变之间的关联是否在性别之间存在差异。方法 来自两个外科中心的 1045 名 BAV 患者（76.0% 男性，n=794）被纳入这项横断面研究。瓣膜表型在术中分为右-左 (RL)、右-非冠状动脉 (RN)、左非冠状动脉 (LN) 或 2 窦 BAV。超声心动图用于确定瓣膜疾病的类型和程度，以及主动脉尺寸。主动脉扩张定义为直径≥4.5 cm。结果 RL 是最常见的表型 (73.6%)，其次是 RN (16.2%)、2 窦 BAV (9.2%) 和 LN (1.1%)，男性和女性的表型分布没有差异 (p=0.634) . 主动脉瓣关闭不全 (AI) 患病率与男性瓣膜表型显着不同 (p=0.047)，RL 和 LN 的患病率最高（分别为 34.1% 和 44.0%）。在女性中，RN 的 AI 比例高于 RL（21.3% vs 7.3%，p=0.017）。患有 RL 的男性根部尺寸较大，特别是在鼻窦处（与 RN 相比，平均差异为 0.24 厘米，p=0.002）。患有 2 窦 BAV 的男性牙根表型扩张的患病率最高（7.0%，其他表型 ≤2.3%，p=0.031），而患有 2 窦 BAV 的女性没有牙根扩张和较小的窦尺寸（平均差：0.35 cm 与 RL 相比，p = 0.021）。与主动脉瓣狭窄相比，AI 男性的主动脉根段更大（窦平均差：0.40 cm，p<0.001）。女性的差异更大（平均差异：0.78 cm，p<0.001），患有 AI 的女性也有更大的管段（平均差异：0.61 cm，p=0.001）。结论 BAV 表型的临床关联存在显着的性别差异，在进一步研究表型在个体化患者管理中的作用时应考虑这一点。所有与研究相关的数据都包含在文章中或作为补充信息上传。身份不明的参与者数据。