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Durability of Aortic Valve Cusp Repair With and Without Annular Support
Ahmad Zeeshan1, Jay J Idrees1, Douglas R Johnston1
1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
Aortic valve repair is effective for valve dysfunction, with specific techniques like figure-of-8 sutures offering the best long-term durability. Severe aortic regurgitation (AR) increases the risk of repair failure.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Aortic Valve Dysfunction
Background:
- Assessing the long-term efficacy of aortic valve repair versus replacement.
- Evaluating various contemporary aortic valve repair techniques.
Purpose of the Study:
- To determine the value and late outcomes of aortic valve repair techniques.
- To identify factors influencing repair success and durability.
Main Methods:
- Analysis of 1,124 patients undergoing planned aortic valve repair between 2001-2011.
- Detailed assessment of multiple repair techniques including commissural sutures, cusp repair, and root procedures.
- Evaluation of in-hospital outcomes and long-term freedom from reoperation.
Main Results:
- Repair was aborted for replacement in 10% of patients, primarily due to severe aortic regurgitation (AR) and calcification.
- Long-term freedom from aortic valve reoperation was 90% at 10 years.
- Commissural figure-of-8 suspension sutures and annular support techniques demonstrated superior durability.
- 10-year AR severity was none/mild in 53% of patients, with root procedures associated with less severe postoperative AR.
Conclusions:
- Aortic valve repair is an effective and durable treatment for aortic valve dysfunction.
- Preoperative AR severity is a key predictor of repair failure.
- Techniques involving commissural figure-of-8 suspension sutures and annular support offer the best long-term outcomes.
Background:
To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era.
Methods:
From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]).
Results:
Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001).
Conclusions:
Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.
