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

Abstract

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.