Early and Long-term Outcomes After Aortic Valve Repair: A Systematic Review

Abstract

Objectives: To describe, through a systematic review, early and long-term outcomes after aortic valve repair (AVR). Methods: A literature review was performed using 2 databases. Studies with sample size above 200 patients, mean/median follow-up above 5 years and that reported mortality and/or reoperation outcomes were included. Papers addressing outcomes of pediatrics disease, endocarditis or aorta coarctation were excluded. Results: Out of 1729 titles identified, 22 were included. Two studies evaluated AVR in exclusively bicuspid aortic valves and one assessed AVR results for aortic dissection. The remaining studies focused on root procedures (n=10) or reported AVR in heterogeneous samples of patients presenting with aortic insufficiency (n=9). Studies' sample size ranged between 220 and 1015, totaling 9965 patients. Regarding early results, hospital mortality occurred in 2.3% of patients (reported by 18 studies), bleeding problems in 5.6% (14 studies), myocardial ischemia in 0.8% (9 studies) and neurological events in 2.2% (17 studies). Pacemaker implantation was needed in 2.2% (9 studies) and 16.2% of patients developed postoperative aortic insufficiency (11 studies). Survival rates at 5-, 10-, 15- and 20-years ranged between 86% and 99% (reported by 10 studies), 62% and 94% (15 studies), 43% and 96% (6 studies) and 70% and 82% (3 studies), respectively. Freedom from reoperation at 5-, 10-, 15-and 20- years rounded between 87% and 100% (11 studies), 62% and 97% (17 studies), 52% and 95% (8 studies) and 70% and 95% (2 studies), respectively. Conclusion: AVR can be considered a safe procedure, revealing satisfactory early and long-term outcomes.