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BACKGROUND:
To determine the long-term durability of aortic valve repair and risk factors for failure.
METHODS:
From 9/1967 to 7/2003, 956 patients had aortic valve repair that included a surgical procedure on the leaflets. Etiologies of aortic valve dysfunction were degenerative (702/956, 73%), rheumatic (195/956, 20%), and endocarditis (59/956, 6%); patients with aortic root pathology were excluded. Aortic valve dysfunction was pure regurgitation (457/523, 87%), pure stenosis (19/523, 4%), and mixed lesions (20/523, 4%). Durability was assessed by freedom from reoperation, with median follow-up of 3 years and 3344 patient-years of follow-up available for analysis.
RESULTS:
Freedoms from aortic valve replacement for repair failure were 86%, 69%, and 50% at 5, 10, and 15 years, respectively. There were 87 immediate repair failures requiring aortic valve replacement at the initial operation. Risk factors for late replacement included CUSA valvuloplasty, tricuspid morphology, and leaflet debridement for aortic stenosis.
CONCLUSIONS:
Repair is most reliable for patients with bicuspid morphology and aortic regurgitation. Durability is jeopardized in patients with aortic stenosis and tricuspid morphology. Selective application is warranted in patients with endocarditis and tricuspid morphology to optimize results.