Outcomes of Aortic Valve Repair: A Systematic Review and Meta-Analysis Using Reconstructed Individual Patient Data

Abstract

Objectives: The increasing interest in Aortic Valve Repair (AVRep) and Valve-Sparing Root (VSR) procedures has led to more clinical studies and data. We conducted a systematic review and meta-analysis to assess outcomes and predictors of mortality and reoperation. The review focused on studies with ≥200 adult patients undergoing AVRep or VSR, with a minimum mean follow-up ≥5 years. Methods: A comprehensive search was conducted on PubMed and ISI-Web of Knowledge (last search December 2024). Short-term outcomes were summarized using weighted descriptive statistics. Study quality was assessed using the New-Ottawa Scale. Forest and funnel plots were used to evaluate heterogeneity and publication bias. Individual patient data were extracted from Kaplan-Meier curves, and a mixed-effects Cox model identified study-level predictors. Results: A total of 48 studies published between 2006 and 2023 were included, encompassing 21,356 patients with a mean age of 52,4 years. Weighted early-outcomes included hospital mortality (1,36% [1,06;1,75]), bleeding (3,73% [2,74;5,06]), myocardial ischemia (0,48% [0,29;0,80]), pacemaker implantation (1,06% [0,66;1,70]), neurological events (1,33% [1,00;1,77]), and postoperative aortic insufficiency (3,38% [1,78;6,32]). Pooled survival at 1-, 5-, 10- and 20-years of follow-up was 96,8%, 92,5%, 83,8% and 67%, respectively; and freedom from reoperation at 1-, 5-, 10- and 20-years of follow-up was 97,9%, 93,9%, 88,2% and 77,5%, respectively. Factors such as older age, female sex, and aortic dissection were associated with higher mortality, while root repair had a protective effect. Conclusion: In conclusion, AVRep and VSR show low early mortality and promising long-term durability, though reporting remains inconsistent, underlining the need for standardized definitions and randomized trials.