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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Aortic valve repair versus mechanical valve replacement for root aneurysm: the CAVIAAR multicentric study

Emmanuel Lansac1, Isabelle Di Centa2, Pichoy Danial1

  • 1Department of Cardiac Surgery, CHU Pitié Salpetriere, Paris, France.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 18, 2022
PubMed

Insights

Aortic valve repair shows a trend towards better outcomes than replacement, with significantly fewer valve-related deaths and bleeding events. Further long-term studies are needed to confirm these findings for aortic aneurysm patients.

Area of Science:

  • Cardiovascular Surgery
  • Aortic Valve Disease
  • Aneurysm Repair

Background:

  • Aortic valve repair is increasingly recognized for improving patient outcomes and quality of life.
  • However, aortic valve replacement remains the predominant treatment for aortic valve disease and aortic root aneurysms.
  • This study investigates the comparative efficacy of aortic valve repair versus replacement in patients with dystrophic aortic root aneurysm.

Purpose of the Study:

  • To evaluate the long-term effects of aortic valve repair (REPAIR) versus aortic valve replacement (REPLACE) in patients with dystrophic aortic root aneurysm.
  • To compare a composite primary outcome including mortality, reoperation, thromboembolic events, major bleeding, endocarditis, infections, pacemaker implantation, and heart failure.
  • To assess secondary outcomes such as major adverse valve-related events and their individual components.

Main Methods:

  • The study utilized a multicentric prospective cohort design (CAVIAAR study) with 261 patients.
  • 130 patients underwent standardized aortic valve repair (REPAIR) involving root remodeling and annuloplasty.
  • 131 patients received mechanical composite valve and graft replacement (REPLACE). Propensity score-weighted Cox model analysis was employed.

Main Results:

  • Up to 4 years, the primary composite outcome did not significantly differ between REPAIR and REPLACE groups (HR 0.66 [0.39; 1.12]).
  • Aortic valve repair demonstrated significantly lower rates of valve-related deaths (HR 0.09 [0.02; 0.34]) and major bleeding events (HR 0.37 [0.16; 0.85]).
  • The REPAIR group experienced half the occurrence of major adverse valve-related events (HR 0.51 [0.31; 0.86]) without an increased risk of reoperation.

Conclusions:

  • While the primary outcome showed no significant difference, aortic valve repair exhibited a favorable trend with reduced valve-related mortality and bleeding.
  • Aortic valve repair appears to be a safe and effective alternative to replacement in selected patients with aortic root aneurysm.
  • Long-term follow-up beyond 4 years is necessary to definitively confirm these findings and the durability of aortic valve repair.
Abstract

Keywords:
Aortic insufficiencyAortic root aneurysmAortic valve repairRemodelling

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