(Almost) All Nonstenotic Bicuspid Aortic Valves Should Be Preserved or Repaired

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Aortic Valve Repair

Background:

• Bicuspid aortic valve (BAV) regurgitation often necessitates surgical intervention.
• Valve repair, when feasible, is preferred over replacement to minimize long-term complications.

Purpose of the Study:

• To determine the proportion of BAVs amenable to repair versus replacement.
• To analyze reasons for aortic valve replacement in BAV patients.

Main Methods:

• Retrospective analysis of 1168 operations for BAV without stenosis (2000-2018).
• Categorization of procedures into aortic valve replacement or repair.
• Review of indications for valve replacement.

Main Results:

• 1055 out of 1168 patients (approx. 90%) underwent BAV repair.
• The repair rate remained consistent at approximately 85% throughout the study period.
• Primary reasons for replacement included cusp calcification or active endocarditis; intraoperative conversion after failed repair was rare (2 cases).

Conclusions:

• The majority of bicuspid aortic valves with regurgitation can be successfully repaired.
• Successful BAV repair with good durability is achievable when adequate cusp tissue is present.