Abstract 1375 Aortic valve repair is associated with a better 1-year survival than aortic valve replacement: results from the German Aortic Valve Registry

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Aortic valve repair is associated with a better 1-year survival than aortic valve replacement: results from the German Aortic Valve Registry
E. Girdauskas¹, S. Bleiziffer², Ü. Balaban³, R. Bekeredjian⁴, H. Möllmann⁵, T. Bauer⁶, E. Herrmann³, A. Beckmann⁷, C. Frerker⁸, S. Ensminger⁹, T. Walther¹⁰, für die Studiengruppe: GARY
¹Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg; ²Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; ³Universitätsklinikum Frankfurt, Frankfurt am Main; ⁴Innere Medizin III / Kardiologie, Robert-Bosch-Krankenhaus, Stuttgart; ⁵Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund; ⁶Medizinische Klinik I, Sana Klinikum Offenbach GmbH, Offenbach; ⁷Klinik für Thorax- und Kardiovaskularchirurgie, Herzzentrum Duisburg, Duisburg; ⁸Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ⁹Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck; ¹⁰Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main;
Objectives: Aortic valve (AV) repair is an evolving surgical strategy in the treatment of non-elderly adults with aortic regurgitation (AR). We aimed to determine the clinical outcome following AV repair/AV sparing root surgery vs. AV replacement using real-world data from the German Aortic Valve Registry (GARY). Methods: A total of 2327 patients with AR (mean age 55.2±15.0 years, 76% men, mean STS score 1.29 ± 0.06), who underwent AV repair/AV sparing root surgery during a period of five years (2011–2015) were included in the GARY registry. During the same period, a total of 40.541 patients underwent aortic valve replacement. A weighted propensity score model, including variables age, gender and STS Score was used to correct for baseline differences between cohorts (i.e., AV repair vs. AV replacement). Primary endpoint was 1-year survival after AV repair vs. AV replacement in the propensity score weighted cohorts. Secondary endpoints were freedom from cardiac adverse events and freedom from AV reinterventions at 1-year follow-up. Results: One-year survival (95% CI) was 97.7% (97.1-98.3) in the AV repair cohort vs. 96.6% (95.8-97.0) in the propensity score-weighted AV replacement cohort (p=0.045). Multivariate Cox regression analysis revealed a significant impact of AV repair (HR 0.68, 95%CI (0.51-0.90), p< 0.0001) on 1-year survival, which was independent of age. Furthermore, AV repair was associated with a significantly better improvement in several patient-reported outcome (PROs) categories, as measured by EQ5 questionnaire. One-year cardiac adverse event-free survival (95% CI) was 85.7% (83.2-87.1) in the AV repair group vs. 84.4% (81.1-85.4) in the AV replacement group (p=0.13). A total of 38 (1.6%) AV repair patients required AV reintervention during a 1-year follow-up, as compared to 1.5% in the AV replacement coho (p=0.30). Conclusion: AV repair surgery was associated with a significantly better 1-year survival as compared to AV replacement in the real-world prospective GARY registry. The survival benefit in the AV repair cohort occurred independently of patients’ age.
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