Valve Repair Versus Replacement in Isolated Aortic Insufficiency: A Propensity Match Analysis.
Giovanni Battista Luciani, Gianluca Lucchese, Salvatore Torre, Giovanni Benfari, Riccardo Abbasciano, Alessio Rungatscher, Giuseppe Faggian.
University of Verona, Verona, Italy.
OBJECTIVE: While satisfactory late outcome has been reported when aortic valve repair is associated to concomitant root replacement, results of isolated valve repair remain controversial. The present study aimed to define whether aortic valve repair is associated with incremental valve-related complications late after surgery.
METHODS: All consecutive adult patients (n=320) with isolated aortic insufficiency having elective valve repair (Group 1) or replacement (Group 2) between 01/2002 and 12/2013 were prospectively studied. Treatment choice was non-random. Group 1 (n=76) and Group 2 (n=244) patients had similar mean age (58±16 vs. 61±14 years, p=0.2) and gender distribution (16/76 vs. 53/244 female, p=0.9), but congenital valve disease (37/76 vs. 73/244, p=0.02) and ascending aortic graft replacement (46/76 vs. 65/244, p=0.001) were more prevalent in Group 1. To accommodate for patient heterogeneity, propensity matching was performed based on 4 variables (age, gender, etiology, associated ascending aortic procedure), which allowed to identify 48 pairs. Study end-points were survival, freedom from MACCE, freedom from aortic valve reoperation, functional status at follow-up.
RESULTS: There was no hospital and 25 late deaths (4/76, 5.3% vs. 21/244, 8.6%, p=0.2), during a mean follow-up of 6.2±4.1 years (range 1-13). Kaplan-Meier analysis showed similar 8-year survival (84±15% vs. 88±12%, p=0.9), freedom from cardiovascular events (77±22% vs. 73±27%, p=0.7) and from reoperation on the aortic valve (90±9% vs. 92±7%, p=0.7) after repair or replacement. Acquired aortic valve disease was associated with greater prevalence of cardiovascular events (HR= 2.28, CI 95% 1.79-4.97) at Cox regression univariate analysis, but not at multivariate. After propensity matching, freedom from MACCE still proved comparable (68±32% vs. 76±24%, p=0.7). Prevalence of NYHA class I was similar among late survivors (58/71 vs. 162/223, p=0.2), while need for chronic anticoagulation was more common among AVR patients (4/71 vs. 53/223, p=0.005).
CONCLUSIONS: Isolated valve repair for pure insufficiency does not incur into increased valve-related morbidity, particularly reoperation. Valve repair seems rational in young, active patients desiring to avoid chronic anticoagulation.
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