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Funding Acknowledgements none Background No data are available regarding the natural history and outcomes of middle-aged European patients with bicuspid aortic valve(BAV), as the only 2 large studies were conducted on the other side of the Atlantic. Purpose To determine the frequency of cardiovascular events and to assess the survival relative to that of the general population(GP) in a large population of adults diagnosed with BAV according to the presence or the absence of a surgical indication at baseline. Methods Between 2005 and 2017, 350 patients without surgical indication (mean age 53, 71% men) and 191 patients with surgical indication (mean age 59, 71% men) at baseline were included. Median follow-up was 80 months. Results In the medical group, 34 deaths(9.7%) were recorded(10 cardiovascular). The 10-years survival rate was 88 ± 2% with a relative survival compared to the age-and-sex matched population of 98.8%. Nine patients(2.6%) were diagnosed with infective endocarditis (IE) and no aortic dissection occurred. Aortic valve and/or ascending aorta surgery was performed in 102 patients(29%) during follow-up. In the surgical group, 12 deaths(6.3%) were recorded(5 cardiovascular). The 10-years survival rate was 90 ± 3% with a relative survival compared to the matched population of 99.2%. Five patients(2.6%) were diagnosed with IE and no aortic dissection occurred. Conclusion Middle-aged adults with BAV have a high likelihood of surgery but a survival comparable to the GP. The rate of IE is low and no aortic dissection occurred in our study. Abstract P1762 Figure. a) survival curves B) surgery incidence

P1762 Natural history and outcome of adults with bicuspid aortic valve: a middle-aged french cohort of 541 patients