ArticleJTCVS structural and endovascular2026
Medium-term outcomes of aortic valve-sparing procedure in trileaflet valve: Longitudinal analysis from the Heart Valve Society Registry.
Article in JTCVS structural and endovascular, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: The aortic valve-sparing procedure has been performed for more than 2 decades and has proven durable results in several aortic and root phenotypes. Few studies have analyzed the impact of aortic valve regurgitation on the need for leaflet repair and outcomes after trileaflet aortic valve-sparing surgery. The aim of this study is to analyze in a large cohort the clinical and echocardiographic outcomes of trileaflet aortic valve-sparing surgery in patients with aortic root dilatation, focusing on the impact of preoperative aortic regurgitation and cusp repair. Methods: We extracted the data from the Heart Valve Society Aortic Registry (previously also known as AVIATOR). We selected patients with trileaflet aortic valves undergoing operations for aortic root dilatation (root/ascending aorta ≥45 mm) by the valve-sparing procedure. The primary outcome was the incidence of moderate or more aortic insufficiency and progression level of aortic insufficiency of at least 1 grade at follow-up. A cusp repair score was created as the cumulative sum of all leaflet repair techniques used per patients. Results: A total of 1116 patients were included in the analysis. Mean age of patients was 53 ± 15 years, and 84% were male. The observed incidence of moderate/severe aortic insufficiency at 1, 5, and 10 years was 0.7%, 3%, and 6.8%, respectively. Both moderate or more aortic insufficiency and progression of aortic insufficiency by 1° increase significantly with time. Preoperative aortic insufficiency and the need for additional clamping sessions were independent predictors of aortic insufficiency progression, whereas the cusp repair score increases the risk of aortic insufficiency of moderate or more. Conclusions: In patients with trileaflet aortic valves undergoing sparing surgery, preoperative aortic insufficiency and the need of a more extensive cusp repair increase the long-term risk of aortic insufficiency. Time also impacts the recurrence of aortic insufficiency or its increase.
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