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.
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.