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Peer-reviewedCC BYJTCVS open

Aortic valve repair versus biological replacement for aortic regurgitation with or without ascending aortic aneurysm: Heart Valve Society Aortic Valve Database Study.

  • Pichoy Danial1
  • Adine R de Keijzer2,3
  • Johanna J M Takkenberg3
  • Vincent Chauvette4
  • Laurent de Kerchove5
  • Jolanda Kluin3
  • Claudia Romagnoni6
  • Peter Verbrugghe7
  • Pascal Leprince1
  • Kevin M Veen3
  • Emmanuel Lansac1
7 affiliations
  1. 1Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  2. 2Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
  3. 3Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
  4. 4Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Heart Institute, Montréal, Canada.
  5. 5Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
  6. 6Department of Cardiothoracic Surgery, IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
  7. 7Department of Cardiovascular Sciences, Cardiac Surgery Unit, Leuven, Belgium.
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Abstract

Objective

To compare the long-term outcomes of aortic valve repair (AVr) (REPAIR group) with biological aortic valve replacement (bAVR group).Methods

Adults who underwent REPAIR or bAVR for aortic regurgitation (AR) +/- ascending aortic aneurysm (AscAA), recorded in the Heart Valve Society database until April 2024, were included. Propensity score matching was used to adjust for confounders. Differences in long-term survival, major adverse valve-related events (MAVRE), and other valve-related events were assessed.Results

In total, 7318 patients were included (REPAIR n = 6773, bAVR n = 545). Propensity score matching resulted in 1006 REPAIR patients matched to 530 bAVR patients (median age: 67 years [interquartile range, 59.0-73.0], 22% female). In the matched cohort, early mortality (≤30 days) was comparable between REPAIR and bAVR patients (1.2% vs 2.1%, P = .070). At 7.5 years, overall matched survival was lower in the bAVR group compared to the REPAIR group (73.9% [95% CI, 66.5%-82.1%] vs 85.6% [95% CI, 82.3%-89.3%], P < .001), with a higher proportion of valve-related deaths (bAVR 4.2% vs REPAIR 1.2%, P < .001). At 7.5 years, patients with bAVR had significantly lower freedom from MAVRE (P < .001) and more infective endocarditis (P = .006), and severe valve dysfunction (P < .001) compared to patients with REPAIR. The incidences of aortic valve reintervention (P = .388) and pacemaker implantation (P = .671) were comparable.Conclusions

Among patients in whom repair was deemed feasible and surgery was performed at mainly expert centers, repair was associated with more favorable long-term outcomes, including improved survival, compared with bAVR in an older propensity-matched cohort. These findings support the consideration of AVr when technically feasible in patients with AR, with or without AscAA.

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Cite

BibTeXRIS
BibTeX
@article{danial2026aortic,
  title = {{Aortic valve repair versus biological replacement for aortic regurgitation with or without ascending aortic aneurysm: Heart Valve Society Aortic Valve Database Study.}},
  author = {Pichoy Danial and Adine R de Keijzer and Johanna J M Takkenberg and Vincent Chauvette and Laurent de Kerchove and Jolanda Kluin and Claudia Romagnoni and Peter Verbrugghe and Pascal Leprince and Kevin M Veen and Emmanuel Lansac},
  journal = {JTCVS open},
  year = {2026},
  month = aug,
  doi = {10.1016/j.xjon.2026.102085},
  url = {https://europepmc.org/article/MED/42948464},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Aortic valve repair versus biological replacement for aortic regurgitation with or without ascending aortic aneurysm: Heart Valve Society Aortic Valve Database Study.
AU  - Pichoy Danial
AU  - Adine R de Keijzer
AU  - Johanna J M Takkenberg
AU  - Vincent Chauvette
AU  - Laurent de Kerchove
AU  - Jolanda Kluin
AU  - Claudia Romagnoni
AU  - Peter Verbrugghe
AU  - Pascal Leprince
AU  - Kevin M Veen
AU  - Emmanuel Lansac
PY  - 2026
DA  - 2026/08/26
JO  - JTCVS open
DO  - 10.1016/j.xjon.2026.102085
UR  - https://europepmc.org/article/MED/42948464
AB  - Objective  To compare the long-term outcomes of aortic valve repair (AVr) (REPAIR group) with biological aortic valve replacement (bAVR group).Methods  Adults who underwent REPAIR or bAVR for aortic regurgitation (AR) +/- ascending aortic aneurysm (AscAA), recorded in the Heart Valve Society database until April 2024, were included. Propensity score matching was used to adjust for confounders. Differences in long-term survival, major adverse valve-related events (MAVRE), and other valve-related events were assessed.Results  In total, 7318 patients were included (REPAIR n = 6773, bAVR n = 545). Propensity score matching resulted in 1006 REPAIR patients matched to 530 bAVR patients (median age: 67 years [interquartile range, 59.0-73.0], 22% female). In the matched cohort, early mortality (≤30 days) was comparable between REPAIR and bAVR patients (1.2% vs 2.1%, P = .070). At 7.5 years, overall matched survival was lower in the bAVR group compared to the REPAIR group (73.9% [95% CI, 66.5%-82.1%] vs 85.6% [95% CI, 82.3%-89.3%], P < .001), with a higher proportion of valve-related deaths (bAVR 4.2% vs REPAIR 1.2%, P < .001). At 7.5 years, patients with bAVR had significantly lower freedom from MAVRE (P < .001) and more infective endocarditis (P = .006), and severe valve dysfunction (P < .001) compared to patients with REPAIR. The incidences of aortic valve reintervention (P = .388) and pacemaker implantation (P = .671) were comparable.Conclusions  Among patients in whom repair was deemed feasible and surgery was performed at mainly expert centers, repair was associated with more favorable long-term outcomes, including improved survival, compared with bAVR in an older propensity-matched cohort. These findings support the consideration of AVr when technically feasible in patients with AR, with or without AscAA.
SN  - 2666-2736
ER  -