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

Valve preservation or repair of the regurgitant bicuspid aortic valve (BAV) minimizes valve-related complications. The purpose of the current analysis was to determine the proportion of BAVs than can be repaired. Between 2000 and 9/2018, 1168 operations for BAV without stenotic pathology were performed. Of these, 103 underwent isolated aortic valve replacement, the remaining 1055 individuals underwent valve repair. Reasons for replacement were analyzed. The proportion of repaired BAVs remained constant at 85% over the years. The most frequent reasons for replacement were cusp calcification or active endocarditis. In only 2 instances, replacement was performed as intraoperative conversion after failed repair. The vast majority of BAVs can be repaired with good durability as long as cusp substance is preserved.