Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients

Abstract

The incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair.

The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve–related aortopathy: Full online-only version

“…195–197 However, long-term results remain pending, and some have expressed concerns of increased long-term risk of AS or recurrent insufficiency. 198–200 Further research insights into the different BAV phenotypes will possibly shed more light on the actual risk of these complications after repair/sparing procedures. Given that valve-sparing aortic root replacement is more technically challenging in patients with BAV, such operations should be performed in referral centers by surgeons with substantial clinical experience with the David operation.…”

Clinical Outcomes of the David V Valve-Sparing Root Replacement Compared With Bioprosthetic Valve-Conduits for Aortic Root Aneurysms

“…Some of these issues have been recently addressed with the emergence of long-term data from recent reports demonstrating both low operative mortality and excellent long-term valve durability [17,18]. Predictors of AI after VSRR are controversial but have been reported to be aneurysmal size, preoperative AI, bicuspid valve, cusp repair, or type of VSRR [18][19][20][21][22].…”

Twenty-five year outcomes following composite graft aortic root replacement

“…A recent international debate focused on the question “Can a preserved or repaired aortic valve equal the durability of a biological aortic valve replacement?” The debating team of experts were of mixed opinions on this question. As valve‐sparing experience matures, despite multiple highly supportive medium‐term reports, two recent studies (one multi‐institutional and the other a large single institution experience) have clearly documented a substantial occurrence of significant aortic insufficiency early after the valve‐sparing procedures, and cautions have been voiced . The data provided in the present study regarding short and long‐term outcomes after traditional mechanical and biological aortic root replacement can serve as a benchmark for the evaluation of the advantages and disadvantages of valve sparing procedures for aortic root pathologies.…”