Schneider U, Hofmann C, Schöpe J, et al. - Researchers sought to determine the long-term stability of bicuspid aortic valve (BAV) repair for survival as well as the factors related to repair failure. They also assessed if a differentiated anatomic repair approach may enhance repair stability. Participants were 1,024 patients who had BAV repair for aortic regurgitation or aneurysm between October 1995 and June 2018. At 15 years, the cumulative incidence of reoperation was estimated to be 30.7%. Findings not only revealed excellent survival post-BAV repair but also indicated that a large proportion of BAV repairs will continue to be stable. A marked improvement in repair stability can be achieved by implementing an anatomic repair concept. The factors that were found to be most strongly related to valve failure were: cusp calcification and the requirement for cusp repair using a patch. In those instances, preference should be given to valve replacement.