Big Data Allows Improvement In Aortic Valve Repair; Surgical Outcomes For Specific Aortic Valve Cusp Characteristics
Sulayman el Mathari1, Noor Boulidam1, Frederiek de Heer1, Laurent de Kerchove2, Hans-Joachim Schäfers3, Emmanuel Lansac4, Jos W.R. Twisk1, Jolanda Kluin1.
1Amsterdam University Medical Center, Amsterdam, Netherlands, 2Cliniques Universitaires Saint-Luc, Brussels, Belgium, 3Saarland University Medical Center, Homburg, Germany, 4Pitié-Salpêtrière APHP Hospital, Paris, France.
OBJECTIVE: We investigated the predictive value of aortic valve cusp retraction, calcification and fenestration for aortic valvuloplasty feasibility.
METHODS: The Aortic Valve Research Network Registry of the Heart Valve Society was used as database. Data was collected for 2082 patients who underwent aortic valvuloplasty or aortic valve replacement. Patients were divided into a study and control group. The study population had retraction, calcification or fenestration in at least one aortic valve cusp. Controls had normal or prolapsed cusps.
RESULTS: All studied cusp characteristics demonstrated increased odds for switch to valve replacement. This effect was strongest for cusp retraction, followed by calcification and fenestration (OR = 25.14, p=<.001; OR = 13.50, p=<.001; OR 12.32, p=<.001). Calcification and retraction displayed increased odds for recurrence of severe aortic regurgitation over a mean follow-up of 389 days (OR = 6.67, p=<.001; OR = 4.13, p=.038). Patients with cusp retraction showed increased risk for reintervention at 1 and 2-years follow-up (HR = 5.66, p=<.001; HR = 3.22, p=.007). The cusp fenestration group had neither an increased risk for severe aortic regurgitation recurrence (p=0.57) or reintervention (p=0.88).
CONCLUSIONS: Aortic valve cusp retraction, calcification and fenestration were all related to increased rates of perioperative switch to valve replacement despite intention for repair. Calcification and retraction were associated with recurrence of severe aortic regurgitation. Retraction was related to reintervention. Fenestration was neither associated with severe aortic regurgitation recurrence or reintervention. This indicates that surgeons are well able to identify suitable valve repair candidates in patients with cusp fenestration, but their judgement is less good in patients with cusp retraction or calcification. Future studies should provide more insight in influence of different cusp characteristics on aortic valve repair feasibility. This could contribute to drafting new guidelines for aortic regurgitation treatment. 
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