Does Aortic Valve Leaflet Plication Increase the Risk of Aortic Regurgitation After Valve-Sparing Root Replacement?
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0126
Submission Type:
Abstract Submission
Authors:
Eilon Ram (1), Christopher Lau (1), Alexander Gregg (2) (,3), Michael Rogers (4), N. Bryce Robinson (5), Charles Mack (6), Leonard Girardi (7)
Institutions:
(1) Weill Cornell Medicine, New York, NY, (2) NYP, New York, NY, (3) Weill Cornell Medicine, N/A, (4) University of South Florida, Tampa, FL, (5) New York Presbyterian, New York, NY, (6) Weill Cornell Medical College, Cornell University, Manhasset, NY, (7) Weill Cornell Medical Center, New York, NY
Submitting Author:
Eilon Ram
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Weill Cornell Medicine
Weill Cornell Medicine
Co-Author(s):
*Christopher Lau
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Weill Cornell Medicine
Weill Cornell Medicine
Alexander Gregg
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NYP|Weill Cornell Medicine
NYP|Weill Cornell Medicine
Michael Rogers
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University of South Florida
University of South Florida
N. Bryce Robinson
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New York Presbyterian
New York Presbyterian
*Charles Mack
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Weill Cornell Medical College, Cornell University
Weill Cornell Medical College, Cornell University
*Leonard Girardi
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Weill Cornell Medical Center
Weill Cornell Medical Center
Presenting Author:
Eilon Ram
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Weill Cornell Medicine
Weill Cornell Medicine
Abstract:
Objective: This study compares outcomes of valve-sparing root replacement (VSRR) with and without aortic valve (AV) leaflet plication for repair of aortic insufficiency (AI).
Methods: A retrospective analysis was conducted on 575 patients who underwent VSRR, of whom 77 (13.4%) had VSRR with concomitant AV leaflet plication (VSRR+AVr), while 498 (86.6%) underwent isolated VSRR. The primary outcomes were 10-year freedom from recurrent AI and AV reintervention. Factors associated with moderate or severe AI or AV reintervention were identified using multivariable regression analysis.
Results: The mean age of the cohort was 49.6±14.1 years, with no significant difference between groups (49.5±14.2 vs. 49.7±14.1, p=0.948). Patients in the VSRR+AVr group had a higher incidence of bicuspid AV (64.9% vs. 17.3%, p<0.001) and more preoperative severe AI (68.8% vs. 26.1%, p<0.001). At the end of the operation, no patients had more than mild residual AI, with no significant difference in the rates of mild residual AI between groups (1.3% vs. 2.8%, p=0.696). Perioperative complications were similar between groups (Table). At 10 years, freedom from moderate or severe AI was 87% in the VSRR+AVr group and 89.4% in the isolated VSRR group [HR 0.98 (0.71-1.35), p=0.905]. Leaflet plication was also not associated with a significantly higher risk of AV reintervention [HR 0.86 (0.67-1.1), p=0.232] (Figure).
Conclusion: VSRR with leaflet plication for AI repair does not increase operative mortality or the risk of long-term AI recurrence compared to isolated VSRR. While leaflet plication was predominantly performed in patients with bicuspid valves, the long-term valve function outcomes were comparable. This technique appears safe for patients requiring AI repair in the context of VSRR.
Methods: A retrospective analysis was conducted on 575 patients who underwent VSRR, of whom 77 (13.4%) had VSRR with concomitant AV leaflet plication (VSRR+AVr), while 498 (86.6%) underwent isolated VSRR. The primary outcomes were 10-year freedom from recurrent AI and AV reintervention. Factors associated with moderate or severe AI or AV reintervention were identified using multivariable regression analysis.
Results: The mean age of the cohort was 49.6±14.1 years, with no significant difference between groups (49.5±14.2 vs. 49.7±14.1, p=0.948). Patients in the VSRR+AVr group had a higher incidence of bicuspid AV (64.9% vs. 17.3%, p<0.001) and more preoperative severe AI (68.8% vs. 26.1%, p<0.001). At the end of the operation, no patients had more than mild residual AI, with no significant difference in the rates of mild residual AI between groups (1.3% vs. 2.8%, p=0.696). Perioperative complications were similar between groups (Table). At 10 years, freedom from moderate or severe AI was 87% in the VSRR+AVr group and 89.4% in the isolated VSRR group [HR 0.98 (0.71-1.35), p=0.905]. Leaflet plication was also not associated with a significantly higher risk of AV reintervention [HR 0.86 (0.67-1.1), p=0.232] (Figure).
Conclusion: VSRR with leaflet plication for AI repair does not increase operative mortality or the risk of long-term AI recurrence compared to isolated VSRR. While leaflet plication was predominantly performed in patients with bicuspid valves, the long-term valve function outcomes were comparable. This technique appears safe for patients requiring AI repair in the context of VSRR.
ADULT CARDIAC:
Aorta and Great Vessels
Image or Table
