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.