Temporal Trends in Aortic Valve Surgery: Preserving the Valve
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0326
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Michael Kirsch (1), Jessica Rove (1), John Iguidbashian (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Jessica Rove
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University of Colorado Anschutz
University of Colorado Anschutz
John Iguidbashian
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective
With the approval of TAVR for low-risk patients, surgical aortic valve replacement (AVR) has become primarily used for patients with bicuspid aortic valve disease, especially for younger patients given the limited durability of bioprosthetic TAVR valves. However, for younger patients, the need for lifelong anticoagulation after mechanical AVR places a significant burden on patients with increased risk of bleeding events. As data has emerged regarding the durability of ring annuloplasty, particularly in bicuspid aortic valve patients, our institution has adopted their use not just in bicuspid aortic valve patients, but also in patients without aberrant valve anatomy with increased surgeon experience. We sought to evaluate institutional temporal trends in AVR versus aortic valve repair (AVr), including the frequency of valve replacement in root replacement, and the trends in usage of ring annuloplasty.
Methods
Using our prospectively maintained institutional database, we identified patients who underwent aortic valve repair or replacement from 2016-2023 and whether any adjunct root replacement procedure was performed. Furthermore, we analyzed temporal trends annually in repair versus replacement and in valve sparing versus non-valve sparing root replacement. We looked at four-year trends (2016-2019 and 2020-2023) for repair versus replacement in bicuspid aortic valve (BAV) patients and in ring annuloplasty utilization in AVr.
Results
529 patients were identified who underwent aortic valve repair or replacement from 2016-2023, with 183 (34.6%) undergoing AVr, and 346 (65.4%) undergoing AVR. Among these patients, 295 (55.8%) had an adjunctive root replacement procedure. Annually, there was a significant increasing trend toward aortic valve repair (p<0.001), and a trend toward valve-sparing root replacement (p=0.009). Regarding four-year trends, there was a significant increase in the utilization of ring annuloplasty (p<0.001), and a significant increase in aortic valve repairs in BAV patients (p= 0.027). Prior to 2020, only 54 aortic valve repairs were performed, with a large increasing following.
Conclusions
A significant institutional trend in performing aortic valve repair and in preserving the aortic root was seen across an 8-year trend at our institution. Our data suggested that at least 50 aortic valve repairs, which can be more challenging to ensure a durable repair, particularly in bicuspid patients, are required to ensure adequate comfort in performing the procedure routinely. Thus, we advocate for the performance of aortic valve repairs at experienced centers.
With the approval of TAVR for low-risk patients, surgical aortic valve replacement (AVR) has become primarily used for patients with bicuspid aortic valve disease, especially for younger patients given the limited durability of bioprosthetic TAVR valves. However, for younger patients, the need for lifelong anticoagulation after mechanical AVR places a significant burden on patients with increased risk of bleeding events. As data has emerged regarding the durability of ring annuloplasty, particularly in bicuspid aortic valve patients, our institution has adopted their use not just in bicuspid aortic valve patients, but also in patients without aberrant valve anatomy with increased surgeon experience. We sought to evaluate institutional temporal trends in AVR versus aortic valve repair (AVr), including the frequency of valve replacement in root replacement, and the trends in usage of ring annuloplasty.
Methods
Using our prospectively maintained institutional database, we identified patients who underwent aortic valve repair or replacement from 2016-2023 and whether any adjunct root replacement procedure was performed. Furthermore, we analyzed temporal trends annually in repair versus replacement and in valve sparing versus non-valve sparing root replacement. We looked at four-year trends (2016-2019 and 2020-2023) for repair versus replacement in bicuspid aortic valve (BAV) patients and in ring annuloplasty utilization in AVr.
Results
529 patients were identified who underwent aortic valve repair or replacement from 2016-2023, with 183 (34.6%) undergoing AVr, and 346 (65.4%) undergoing AVR. Among these patients, 295 (55.8%) had an adjunctive root replacement procedure. Annually, there was a significant increasing trend toward aortic valve repair (p<0.001), and a trend toward valve-sparing root replacement (p=0.009). Regarding four-year trends, there was a significant increase in the utilization of ring annuloplasty (p<0.001), and a significant increase in aortic valve repairs in BAV patients (p= 0.027). Prior to 2020, only 54 aortic valve repairs were performed, with a large increasing following.
Conclusions
A significant institutional trend in performing aortic valve repair and in preserving the aortic root was seen across an 8-year trend at our institution. Our data suggested that at least 50 aortic valve repairs, which can be more challenging to ensure a durable repair, particularly in bicuspid patients, are required to ensure adequate comfort in performing the procedure routinely. Thus, we advocate for the performance of aortic valve repairs at experienced centers.
Aortic Symposium:
Other - Aortic Valve
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