Aortic Valve Repair for Aortic Insufficiency or Dilatation: Technical Evolution and Long-term Outcomes.

Abstract Background Aortic valve repair is an attractive alternative to valve replacement for the treatment of aortic valve insufficiency. Hereby, we report on the mid-term outcomes after aortic valve repair for aortic valve insufficiency with emphasis on durability of repair. Methods Between 1996 and 2017, 560 consecutive patients (mean age 56 ± 16 years) underwent various aortic valve repair procedures on tricuspid (n=415, 74%) and bicuspid aortic valve (n=145, 26%). In 313 patients (56%) the David procedure was performed. Cusp repair without aortic root procedure was applied in 247 (44%) patients. Concomitant procedures were CABG (Coronary artery bypass grafting) in 82 (15%) patients and mitral valve repair in 47 patients (8%). Clinical and echocardiographic follow-up were complete in 97%. Mean follow-up was 6.3 ± 4.6 years. Results Thirty-day mortality was 1.4% (n=8). Late mortality was observed in 132 patients with cardiovascular events accounting for mortality in 13 patients: survival at 10 years was 70%. Reoperation on the aortic valve was performed on 39 patients for recurrent insufficiency, isolated in 25 or combined with valve stenosis in 5 patients; endocarditis accounted for reoperation in 9 patients (0.2 %/patient year). Freedom from reoperation was 88% at 10 years. Cumulative linearized incidence of all valve-related complications was 2% per patient per year. Conclusions Aortic valve repair for insufficiency is a durable procedure with low valve-related morbidity and mortality in mid-term.