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Early and long-term outcomes after aortic valve repair: a systematic review and meta-analysis using reconstructed individual patient data
Session:
SESSÃO DE POSTERS 50 - DIAGNÓSTICO E PROGNÓSTICO NA CIRURGIA CARDÍACA
Speaker:
João Mascarenhas
Congress:
CPC 2025
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
22. Aortic Disease
Subtheme:
22.4 Aortic Disease - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
João Mascarenhas; Rui Cerqueira; Maria Rodrigues; Joana Miranda; Inês Sousa; Adelino Leite-Moreira; Francisca Saraiva; Samuel Heuts
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> The growing interest in Aortic Valve Repair (AVRep) and Valve Sparing Root procedures in adults has prompted a surge in clinical studies and available data. This systematic review aims to examine early and long-term outcomes of AVRep and Valve Sparing Root Procedures procedures.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> A systematic search was conducted across two electronic databases, with predetermined criteria agreed upon by all co-authors: Studies with a sample size greater than 200 patients, a mean or median follow-up duration of at least 5 years, and data on at least mortality or reoperation outcomes. Descriptive statistics were weighte<span style="font-family:Arial,Helvetica,sans-serif">d by sample size for short-term outcomes. Individual patient data (IPD) were graphically extracted from Kaplan-Meier survival curves to represent pooled long-term</span> outcomes. </span></span></span><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000">Additionally, we performed a study-level Cox-regression model, using as covariates patient age, sample size, study publication year, non-tricuspid aortic valve, dissection, concomitant aortic arch procedure or cardiac surgery, aortic insufficiency and aortic root surgery.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 48 studies published between 2006 and 2023 were included, encompassing a cumulative sample of 21,360 patients with a mean age of 52.4 (50,0-55,0) years. Root procedures were the focus in 27 studies, and AVR for heterogeneous samples of patients with aortic insufficiency was analyzed in 41 studies. Four studies focused exclusively on bicuspid aortic valve patients. Early outcomes showed a pooled incidence rate of 1.36% [1,06; 1,75] for hospital mortality, 3.73% [2,74; 5,06] for bleeding, 0.48% [0,29; 0,80] for myocardial ischemia, 1.06% [0,66; 1,70] for pacemaker implantation, and 1.33% [1,00; 1,77] for neurological events. Pooled analysis revealed a 3,38% [1,78; 6,32] incidence of postoperative aortic insufficiency of any degree in the short term. Regarding long-term outcomes and joining IPD survival data from 36 articles, combined using Guyot’s algorithm to pool data, an overall survival curve was generated (n=16612, Figure 2) with median follow-up time of 6,42 years, maximum 26,82 years. Survival at 1-, 5-, 10-, 15- and 20-years of follow-up was 96,8%, 92,5%, 83,8%, 75,2% and 67%, respectively. Joining IPD reoperation data from 41 articles, an overall freedom from reoperation curve was generated (n=17569, Figure 2) with median follow-up time 5,39 years, maximum 26,38 years. Pooled freedom from reoperation at 1-, 5-, 10-, 15- and 20-years of follow-up was 97,9%, 93,9%, 88,2%, 83,6% and 77,5%, respectively.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> AVR is generally performed in a low risk setting and has a favourable safety profile. However, the quality of evidence remains low due to high heterogeneity in outcome reporting, and randomized trials comparing AVR to other surgical alternatives are scarce. Standardizing outcome reporting is essential for improving the scientific value of future research.</span></span></span></p>
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