Impact of aortic valve
preservation
Aortic valve replacement (AVR) may be considered to treat AR in such
cohorts. However, implantation of a prosthetic valve has a negative
impact on long-term prognosis, especially in young patients. A recent
meta-analysis revealed rates of structural valve deterioration and
reintervention of 1.59% and 1.82% annually in a relatively young
cohort (50.7 ± 11.0 years old) undergoing bioprosthetic
AVR5. For patients aged 25 or 35 years old, lifetime
risk of reintervention due to structural valve deterioration of the
bioprosthesis was almost 100%, and therefore life expectancy in this
population was less than two thirds of that in the age- and sex-matched
general population5. On the other hand, aortic root
replacement with a mechanical composite graft was associated with an
increased risk of thromboembolic events (0.7%/year) compared with
valve-sparing root replacement (VSRR) (0.3%/year)6.
Accordingly, aortic root replacements using the both biological and
mechanical composite graft were associated with increased major adverse
valve-related events compared with VSRR (hazard ratio: 3.4 and 5.2,
respectively)7.
Therefore, pioneers in aortic valve-preserving surgery (AVP) have
recently reported that patients who had undergone AVP had significant
survival benefit over those undergoing AVR (Fig. 2)7,
8. In addition, due to recent advances in AVP, the reintervention rate
has become comparable with AVR, and better than bioprosthetic AVR in
younger populations (Fig. 3)7, 8. Therefore, AVP has
attracted increasing attention over the last decade.