Objectives: Current national registries are lacking detailed pathology-driven analysis and long-term patients outcomes. The Heart Valve Society (HVS) aortic valve (AV) repair research network started the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) to evaluate long-term patient outcomes of AV repair and replacement. The purpose of the current report is to describe the AVIATOR initiative and report in a descriptive manner the patients included. Methods:The AV repair research network includes surgeons, cardiologists, and scientists and established an online database compliant with the guidelines for reporting valve-related events. Prospective inclusion started from January 2013. Adult patients (18 years or older) who were operated on between 1995 and 2017 with complete procedural specification of the type of repair/replacement were selected for descriptive analysis.Results: Currently 58 centers from 17 countries include 4896 patients with 89% AV repair (n ¼ 4379) versus 11% AV replacement (n ¼ 517). AV repair was either isolated (28%), or associated with tubular/partial root replacement (22%) or valve-sparing root replacement (49%) with an in-hospital mortality of 0.5%, 1.7%, and 1.2%, respectively. AV replacement was either isolated (24%), associated with tubular/partial root replacement (17%) or root replacement (59%) with an in-hospital mortality of 1%, 2.6%, and 2.0%, respectively. Conclusions:The multicenter surgical AVIATOR registry, by applying uniform definitions, should provide a solid evidence base to evaluate the place of repair versus replacement on the basis of long-term patient outcomes. Obtaining data completeness and adequate representation of all surgery types remain challenging. Toward the near future AVIATOR-medical will start to study natural history, as will AVIATOR-kids, with a focus on pediatric disease.

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Background: Bicuspid aortic valve (BAV) is the most frequent congenital heart disease affecting 1% to 2% of the population, with thoracic aortic aneurysm (TAA) formation being its second most frequent complication after aortic valve dysfunction (stenosis or insufficiency). Aortic valve replacement (AVR) with mechanical or biologic prostheses has long been the procedure of choice. Although prosthetic AVR is effective in correcting the hemodynamic problem, there are important long-term drawbacks. These are particularly present in a younger patient population, such as the majority of individuals with a BAV. Patient and methods: 40 patients underwent aortic valve repair for bicuspid aortic valve disease with ascending aortic aneurysm in the period between June 2020 and February 2022 in Kasr Alainy hospitals. Results: All our patients showed significant improvement regarding left ventricular dimensions and contractility. Two patients had mild to moderate regurge and thirty eight patients had non-significant regurge in the six month follow up echo. One patient complicated by complete heart block required permanent pacemaker implantation, another two patients had postoperative high drainage required revision for bleeding. One patient died from ventilator associated pneumonia after prolonged mechanical ventilation due to disturbed conscious level.