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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
11.5K
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.
Summary
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.
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