Valve Repair Improves the Outcome of Surgery for Chronic Severe Aortic Regurgitation. A Propensity Score Analysis

de Meester de Ravenstein, Christophe [UCL] Piérard, Sophie F. [UCL] Seldrum, Stéphanie [UCL] Gerber, Bernhard [UCL] Vancraeynest, David [UCL] Pouleur, Anne-Catherine [UCL] Noirhomme, Philippe [UCL] Pasquet, Agnes [UCL] El Khoury, Gebrine [UCL] Vanoverschelde, Jean-Louis [UCL]

Background. For patients with aortic regurgitation (AR), aortic valve (AV) repair represents as an attractive alternative to AV replacement (R), as it does not expose the patients to the risk of prosthetic valve complications. Although the durability of AV repair has been documented, its superiority to prosthetic AVR has not yet been established. Methods. We examined the outcome of 317 consecutive patients who underwent surgical correction of severe AR between 1995 and 2010, of whom 264 underwent AV repair and 53 AVR. Results. Operative mortality was similar in the AV repair and AVR groups (1% vs 4%, p=0.19). Kaplan Meier survival analysis indicated a significantly better overall 6-year survival after AV repair than after AVR (88% vs 69%, log rank p=0.0002). These differences persisted after age adjustment. Cox's proportional survival analysis demonstrated that the choice of treatment was an independent predictor of post-operative survival. To reduce the effect of selection bias, we matched 49 pairs of patients using a propensity score. For these 98 propensity-score matched patients, overall survival remained significantly better after AV repair than after AVR (83% vs 68%, log rank p=0.037). Finally, the improved survival after AV repair was not offset by an increased reoperation rate as re-operation free survival was similar in the 2 groups (96% vs 98%, log rank p=0.52). Conclusion. AV repair significantly improves postoperative outcomes in patients with AR and whenever feasible, should probably be the preferred mode of surgical correction.