Aortic valve repair leads to a low incidence of valve-related complications

Abstract

Objective: Aortic valve replacement for aortic regurgitation (AR) has been established as a standard treatment but implies prosthesis-related complications. Aortic valve repair is an alternative approach, but its mid- to long-term results still need to be defined. Methods: Over a 12-year period, 640 patients underwent aortic valve repair for regurgitation of a unicuspid (n = 21), bicuspid (n = 205), tricuspid (n = 411) or quadricuspid (n = 3) aortic valve. The mechanism of regurgitation involved prolapse (n = 469) or retraction (n = 20) of the cusps, and dilatation of the root (n = 323) or combined pathologies. Treatment consisted of cusp repair (n = 529), root repair (n = 323) or a combination of both (n = 208). The patients were followed clinically and echocardiographically; follow-up was complete in 98.5% (cumulative follow-up: 3035 patient years). Results: Hospital mortality was 3.4% in the total patient cohort and 0.8% for isolated aortic valve repair. The incidences of thrombo-embolism (0.2% per patient per year) and endocarditis (0.16%per patient per year) were low. Freedom from re-operation at 5 and 10 years was 88% and 81% in bicuspid and 97% and 93% in tricuspid aortic valves (p = 0.0013). At re-operation, 13 out of 36 valves could be re-repaired. Freedom from valve replacement was 95% and 90% in bicuspid and 97% and 94% in tricuspid aortic valves (p = 0.36). Freedom from all valve-related complications at 10 years was 88%. Conclusions: Reconstructive surgery of the aortic valve is feasible with low mortality in many individuals with aortic regurgitation. Freedom from valve-related complications after valve repair seems superior compared to available data on standard aortic valve replacement.