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Canadian Journal of Cardiology

AORTIC VALVE REPAIR DECREASES RISKS OF VALVE-RELATED EVENTS IN AORTIC INSUFFICIENCY AT 10 YEARS A PROPENSITY SCORE-MATCHED ANALYSIS

      BACKGROUND

      Aortic valve repair (AVr) has emerged as a feasible and effective alternative to replacement (AVR) in patients with aortic insufficiency (AI), however, little data exists comparing outcomes. Thus, the objective of this study was to compare early and long-term valve related complications between AVr and AVR in the treatment of AI.

      METHODS AND RESULTS

      Single centre, retrospective study of all patients (n=417) undergoing AVr (n=264) or AVR (n=153) for primary AI. Propensity-matching using a 1:1 greedy matching algorithm identified 140 patients using six covariates (age, gender, LV function, LV size, presence of aortopathy, and urgency of operation) for comparison. The primary outcome was a composite of all valve-related events (VRE), including: endocarditis, myocardial infarction (MI), stroke, transient ischemic attack (TIA), thromboembolisms, bleeding, and aortic valve (AV) reoperation. VRE were defined as per published guidelines. Survival and freedom from VRE were reported using the Kaplan-Meier method. Propensity-matching identified 70 well matched pairs with no major differences in baseline demographics, comorbidities, or AI severity (p=0.57). Perioperative outcomes showed no significant differences in VRE (AVR 8 vs AVr 7, p=0.78) or mortality (AVR 3 vs AVr 1, p=0.62). Event-free survival from the primary outcome at 10-years was significantly better after AVr than after AVR (82% vs 68%, p=0.024), with no significant differences in 10-year overall survival between groups (82% vs 72%, p=0.29). No significant differences in AI severity (p=0.07) or reoperation rate (p=0.44) were detected between groups.

      CONCLUSION

      This study demonstrated a lower long-term risk of VRE with repair compared to replacement, with low mortality and comparable durability. Further prospective randomized control trials are necessary to formally compare outcomes and determine superiority.
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