The decision to repair versus replace the aortic valve is based on complex factors, as well as the experience and results of the particular treatment center. At the Comprehensive Aortic Program, a repaired valve is expected to have a life of 10 years or more (comparable to the minimum expectation for a bioprosthesis). If the repaired valve is not projected to last at least that long, the valve is replaced rather than repaired. A repaired valve could last a lifetime. Therefore, in feasible cases, aortic valve repair is always the first choice.
There are factors unique to each patient that must be evaluated regarding valve repair. The anatomy of the aortic valve, nature of the tissue and comfort level of the surgeon in performing the repair all are factors in the resulting durability of the repaired valve. Careful scrutiny is required for bicuspid aortic valves. In young patients where the bicuspid valve functions well with minimal calcification, or if there is localized prolapse of only one leaflet, a durable repair may be possible. When a normal trileaflet aortic valve is present, there is greater potential for repair. Particularly during surgery for ascending aortic dissection involving a normal aortic valve, lifetime durable repairs are often possible.