Repair of the bicuspid aortic valve: A viable alternative to replacement with a bioprosthesis

Objective: We sought to compare the safety and durability of bicuspid aortic valve repair versus replacement with a bioprosthesis. Methods: We reviewed medical records of patients aged 18 years or older undergoing bicuspid aortic valve repair for aortic regurgitation from 1984 through 2007. We analyzed early outcomes and predictors of aortic valve replacement after initial repair. Patients with repair were compared with an age- and sex-matched cohort who had replacement with a bioprosthesis. Overall survival and survival free from reoperations were compared between groups. Results: The mean follow-up period for 108 consecutive patients with repair was 5.1 (standard deviation, 4.1) years. The initially repaired valve was subsequently replaced in 19 (18%) patients. No bicuspid aortic valve repair technique or morphologic characteristic included in univariate risk factor analysis was associated with increased probability of replacement after initial repair. The 5- and 10-year survival rates after repair were 96% and 87%, respectively. Freedom from valve replacement was 96%, 89%, and 49% at 1, 5, and 10 years after repair, respectively. A separate analysis of 81 matched patients with repair or receipt of an aortic valve bioprosthesis showed no significant difference in 10-year survival (72% vs 79%, P = .13) or freedom from reoperation between groups (90% vs 98% and 72% vs 64% in 5 and 10 years, respectively; P < .12). Conclusions: Bicuspid aortic valve repair is a viable alternative to replacement with a bioprosthesis because durability and safety are similar between both surgical management methods for aortic regurgitation. After initial repair, approximately half of the patients require aortic valve replacement within 10 years.