INTRODUCTION Degenerative valve disease is the most common cause of aortic regurgitation (AR) in Western country. These patients are good candidates to aortic valve repair (AVr), avoiding the long-term risks associated with prosthetic substitutes.
METHODS We analyzed retrospectively all AVr procedures with geometric ring annuloplasty at our Division between January 2022 and December 2023.
RESULTS During the study period, 44 patients underwent AVr at our Division. Mean age was 50.4 years and 37 were male. Mean Logistic EuroSCORE was 4.74%. Mean ejection fraction (EF) was 57% and mean left ventricle (LV) end-diastolic diameter (EDD) and volume (EDV) were 55.1 mm and 159.3 ml, respectively. All but one patient had moderate or severe AR (97.8%). The aortic valve was tricuspid in 24 patients (54.6%) and bicuspid in 20 (45.4%), respectively. The bicuspid cohort were younger (mean age 35.15 vs. 63.2 yo) with more dilated LV (mean EDV 173 vs. 144.5 ml) and annulus (28.3 vs. 25.3 mm). 3 patients had previous cardiac surgery procedures.
All patients were operated electively. Cardiopulmonary bypass time was 147.4 min (± 35.7) and aortic cross-clamp time was 124.5 min (± 28.5). In all the patients, AVr was performed with the geometric ring annuloplasty, 24 tricuspid and 20 bicuspid rings. 40 (90.9%) patients needed cusps repair. 22 (50%) patients had concomitant cardiac procedures: 13 patients had ascending aortic replacement (29.5%), 8 mitral valve surgery (1 replacement and 7 repair), 1 tricuspid valve repair, 2 coronary bypass graft and 1 AFib ablation. In 2 patient aortic valve replacement was necessary at the time of AVr because of residual significant AR. Mean length-of-stay in ICU and in hospital were 1 and 6.5 (± 1.7) days. Only 1 patient, already listed for kidney transplantation before surgery, needed dialysis. No other complications were reported, nor intra-operative and in-hospital mortality.
At 6-month echocardiographic follow up, the mean post-operative EF was 54.6%, with LV mean EDD and EDV of 49.3 mm and 133.1 ml, respectively. The mean aortic gradient was 12.6 mmHg (±3.5). Only 1 patient was found with severe AR and was successfully reoperated for valve replacement. Only 1 death occurred after discharge within 30 days of surgery, due to extracardiac pathology.
CONCLUSION In selected centers, AVr for AR is safe and reproducible procedure alternative to replacement with good early results.
