Mid-Term Outcomes of Aortic Valve Repair Without Aortic Root Replacement: A Single-Center Experience

TL;DR

This study examines the mid-term outcomes of aortic valve repair without replacing the aortic root, finding a notable reoperation rate due to recurring aortic regurgitation.

Contribution

The study provides new insights into the mid-term durability and reoperation risks of aortic valve repair without root replacement.

Findings

35.7% of patients required reoperation due to aortic regurgitation recurrence within a median follow-up of 5.5 years.

Patients with more than mild aortic regurgitation at discharge were significantly more likely to need reoperation.

No significant baseline differences were found between patients who needed reoperation and those who did not.

Abstract

Background

Aortic valve (AV) repair is a challenging procedure due to its complexity, lower reproducibility, and steep learning curve. To examine its durability and validity, we investigated mid-term outcomes following AV repair without aortic root replacement.

Methods

Between March 2007 and May 2018, we retrospectively identified 14 patients who underwent AV repair without aortic root replacement at our institution. We investigated their baseline characteristics and postoperative outcomes, including the reoperation rate due to aortic regurgitation (AR) recurrence. Furthermore, we divided them into two groups: those who required reoperation due to AR recurrence (Group R) and those who did not require reoperation (Group F), and statistically compared them.

Results

The median age was 52.5 years (IQR: 42.0-60.8), with 11 male patients (78.6%). Eight patients (57.1%) had a bicuspid AV. Five cases (35.7%) underwent reoperation due to AR recurrence during a median follow-up period of 5.5 years. There were no significant differences in baseline characteristics between Group R (n=5, 35.7%) and Group F (n=9, 64.3%), including AR etiology, AV repair procedure, and intraoperative AR grade after the final declamp. All cases in Group R had at least mild to moderate AR on the echocardiogram before discharge. Regarding the AR grade before discharge, Group R had a significantly higher grade than Group F (p = 0.013).

Conclusions

The indication for AV repair for AR might need to be reassessed due to the considerable mid-term reoperation rate. Cases of AV repair with more than mild AR at discharge should be carefully monitored, as they are likely to require future reoperation for AR.

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