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

Objective: Aortic valve repair/sparing 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 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 the general population in each group. The 10-year cumulative incidence of reintervention was 19.5%(95%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 [HR: 1.95(95%CI:1.19-3.21),p<0.001] and left ventricular end-diastolic diameter [HR: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. Predicted left ventricular ejection fraction (%) initially increased(p < 0.001) and then stabilized.

Conclusion: This study found that aortic valve repair/sparing techniques provide a viable and effective treatment option 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 hemodynamic outcomes with an acceptable hazard of reintervention.