Outcomes of Aortic Valve Repair: A Systematic Review and Meta-Analysis Using Reconstructed Individual Patient Data

The progressive dissemination of isolated aortic valve repair (AVRep) and valve-sparing root (VSR) procedures has resulted in a cumulative expansion of the available literature. This work aims to synthesize the current knowledge and identify predictors of mortality and reintervention in patients undergoing such valve-preserving procedures.

A systematic review and meta-analysis were conducted in 2 databases (last search January 2025). Studies with ≥200 adult patients undergoing AVRep or VSR with a minimum mean follow-up ≥5 years were included. Short-term outcomes were summarized using weighted descriptive statistics. Forest plots, funnel plots, and the Newcastle-Ottawa Scale were used to evaluate the risk of bias. Long-term survival and freedom from reoperation were analyzed through reconstructing individual patient data from Kaplan-Meier curves, and a mixed-effects Cox frailty model was used to identify study-level predictors of these endpoints.

There were 48 studies included, encompassing 20,914 patients with a mean weighted age of 52.42 (50.28 to 54.57) years. Early outcomes included hospital mortality (1.34% [1.04% to 1.73%]), bleeding (3.77% [2.76% to 5.13%]), myocardial ischemia (0.44% [0.26% to 0.77%]), pacemaker implantation (1.00% [0.63% to 1.59%]), neurologic events (1.27% [0.91% to 1.78%]), and postoperative residual aortic regurgitation (3.48% [1.90% to 6.29%]). Pooled survival at 1, 5, 10, and 20 years of follow-up was 96.8%, 92.5%, 83.8%, and 67%, respectively; freedom from reoperation at the same time points was 97.9%, 93.9%, 88.2%, and 77.5%, respectively. Factors such as older age, female sex, aortic dissection, and isolated valve repair were associated with higher mortality.

These findings suggest that AVRep and VSR are associated with low early mortality and morbidity and excellent long-term outcomes. However, heterogeneity in definitions and endpoints across studies underlines the need for standardized definitions and conduction of properly designed randomized trials.