Trends of aortic valve-preserving surgery in japan: an updated five-year nationwide survey.

OBJECTIVE

We evaluated trends and outcomes of aortic valve-preserving surgery (AVPS) in Japan, particularly with regard to aortic regurgitation (AR), in comparison with data from 2014.

METHODS

We conducted a nationwide survey across 244 hospitals in Japan, focusing on aortic valve and aortic root surgeries performed in 2019. The breakdown of procedures, including isolated aortic valvuloplasty (AVP) and valve-sparing root replacement (VSRR), in AR patients was examined, and compared with the results from 2014.

RESULTS

In 2019, the isolated AVP rate for AR was 5.5%, down from 7.5% in 2014. The VSRR rate among aortic root surgeries remained (33.1%). Within VSRR procedures, aortic valve reimplantation (reimplantation) accounted for 62.7% of cases, aortic root remodeling (remodeling) for 32.0%, and other root replacement techniques for 5.3%. AVPS was performed in 102 hospitals, with 10 institutions accounting for 42.2% of all cases. One-year reoperation rates for AVP, reimplantation, remodeling, and other root replacement were 8.0%, 1.8%, 6.0%, and 14.3%, respectively. Short-term (up to 4 years) aortic valve-related reoperation rates for AVP, reimplantation, and remodeling were 9.7%, 6.1%, and 9.5%, respectively. Use of a pericardial patch emerged as an independent risk factor for reoperation following AVPS (P = 0.022; odds ratio 3.382; 95% confidence interval 1.195-9.570).

CONCLUSIONS

The rate of AVP performed for AR in Japan decreased significantly from 2014 to 2019, while the rate of VSRR for root procedures remained stable. Use of a pericardial patch was identified as an independent risk factor for aortic valve-related reoperation following initial repair.