Aortic valve repair in adults: long-term clinical outcomes and echocardiographic evolution in different valve repair techniques.

OBJECTIVES

Aortic valve repair/sparing techniques have been established as effective treatments for aortic regurgitation and/or aortic aneurysms. However, concerns remain regarding long-term durability, reproducibility and patient selection. This study aims to asses long-term clinical and echocardiographic outcomes, with a focus on aortic regurgitation grade and left ventricular ejection fraction evolution, in adults undergoing these procedures.

METHODS

Adult patients in the Heart Valve Society Aortic Valve Database, undergoing any aortic valve repair/sparing technique were included. Time-to-event analyses were used for clinical outcomes and mixed-effects models for left ventricular ejection fraction and aortic regurgitation grade evolution. Techniques: isolated valve repair (group 1), ascending aortic replacement + valve repair (group 2), partial-root replacement ± valve repair (group 3) and valve-sparing root replacement ± valve repair (group 4).

RESULTS

Survival at 10 years was comparable to survival of the matched-general-population in each group. The 10-year cumulative incidence of reintervention was 19.5% [95% confidence interval (CI) 16.70-22.40%] in group 1 [including only double external annuloplasty in group 1; reintervention was not significantly different between techniques (P = 0.112)]; 13.8% (95% CI 10.10-18.10%) in group 2; 12.7% (95% CI 5.50-22.90%) in group 3; and 8.5% (95% CI 7.00-10.10%) in group 4 (P < 0.001). Severe preoperative aortic regurgitation grade [hazard ratio 1.95 (95% CI 1.19-3.21), P < 0.001] and left ventricular end-diastolic diameter [hazard ratio 1.03 (95% CI 1.00-1.05), P < 0.001] were predictive of reintervention in group 4; patch use was a predictor in all groups. The predicted left ventricular ejection fraction (%) initially increased (P < 0.001) and then stabilized.

CONCLUSIONS

This study found that aortic valve repair/sparing techniques provide viable and effective treatment options that should be considered for all eligible patients with aortic regurgitation and/or aortic root/ascending aortic aneurysms, given their potential to restore life expectancy and provide good haemodynamic outcomes with an acceptable hazard of reintervention.