Aortic valve repair for treatment of aortic regurgitation in patients with a bicuspid aortic valve: the experience of a single Polish aortic centre

Bicuspid aortic valve (BAV)-related aortic regurgitation presents heterogeneous anatomic phenotypes that complicate durable valve repair. To ensure repair reproducibility, current guidelines recommend specialised aortic centres with transparent, published outcomes. This report summarizes the two-decade experience of a single Polish aortic centre integrating clinical, imaging, and surgical data to develop a standardized, phenotype-driven repair strategy. Across these institutional studies, commissural symmetry and circumferential annuloplasty consistently emerged as key determinants of durable repair, while advanced imaging demonstrated the superiority of complete annular stabilization over subcommissural techniques. Additional experience with valve-sparing root procedures and geometric ring annuloplasty in highly asymmetric BAVs further contributed to a unified treatment approach. Synthesizing these findings, the review presents a phenotype-driven decision-making algorithm developed at the centre to guide the selection of repair techniques and root interventions, with the aim of standardizing and optimizing long-term outcomes.