Bicuspid-Associated Aortic Root Aneurysm: Mid to Long-Term Outcomes of David V Versus the Bio-Bentall Procedure.

David V valve-sparing root replacement (VSRR) and bio-Bentall (BB) are increasingly performed for aortic root aneurysms associated with a bicuspid aortic valve (BAV). However, durability remains a concern in both procedures. We compared the 10-year outcomes of VSRR versus BB for BAV-associated root aneurysms. A retrospective review identified 134 patients with a BAV-associated root aneurysm who underwent VSRR (n=65) or BB (n=69) from 2005-2019. Patients with aortic stenosis, endocarditis, previous aortic valve replacement, and emergent cases were excluded. Propensity-score matching was performed, resulting in two risk-adjusted groups (n=40 per group). Median follow-up was 6.21 (1.43-8.28) years. The VSRR cohort was younger (46.0 years vs. 56.0 years, p<0.001) and had a lower incidence of at least moderate aortic insufficiency (AI) (78.5% vs. 92.8%, p=0.02). The incidence of Marfan syndrome, aortic root diameter, and ascending aortic diameter were similar. In-hospital mortality was 1.5% (n=1) and 1.4% (n=1) for VSRR and BB, respectively. There was no difference between VSRR and BB in 10-year survival (98.3% [95%CI: 88.6%-99.8%] vs. 96.2% [95%CI: 85.5%-99.0%], p=0.567) and aortic valve reintervention at 10 years (16.1% [95%CI: 6.3%-29.8%] vs. 12.9% [95%CI: 3.7%-28.0%], p=0.309). The most common reason for valve reintervention in both groups was AI. Survival and valve reintervention at 10 years were similar in the matched cohort. David V VSRR yields similar mid to long-term outcomes to BB for select patients with a BAV-associated aortic root aneurysm in regards to survival and reintervention rates. Further studies comparing longer-term outcomes between root replacement techniques and native valve durability are needed. In patients with a root aneurysm associated with a bicuspid aortic valve, David V valve-sparing root replacement and the bio-Bentall procedure may be performed with similar survival and valve reintervention rate at 10 years.