“…This has significant implications, as the burden of surgery for BAV patients in the United States exceeds 1 billion dollars per year, and surgical intervention has doubled over the past decade (Opotowsky et al, 2013). It is noted that surgical planning and decision-making for BAV patients is affected by physician bias and historical local practice within institutions, which aren't always consistent and in line with guidelines (Verma et al, 2013; Della Corte et al, 2014b; Girdauskas and Borger, 2014; Michelena et al, 2014; Verma and Siu, 2014; Sundt, 2015; Wasfy et al, 2015). In a recent survey of 100 cardiac surgeons, it was postulated that attitudes on the etiology, inherited aortopathy vs. acquired from hemodynamic stress, rather than proven clinical evidence dictated surgical treatment of BAV aortopathy (Verma et al, 2013).…”