Mid-term Clinical and Hemodynamic Outcomes in Patients Treated for Aortic Regurgitation and/or Ascending Aorta Aneurysm: The 3-Year Flight of the AVIATOR Registry

Background There are few prospective and large registries on outcomes after aortic valve repair/sparing or replacement in patients with aortic valve regurgitation (AR), with or without ascending aorta aneurysm. Methods A total of 2,026 patients enrolled prospectively in The Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) were included in this analysis. The primary endpoint was the composite of all-cause death or aortic valve and/or aorta reintervention. Results 1,630 (80%) received surgical repair/sparing versus replacement in 396 (20%). During a mean follow-up of 3.8 ± 1.9 years, 187 (9.2%) events occurred, including 106 reinterventions and 81 deaths. The incidence of the composite endpoint was higher in the replacement versus repair group (25.3% vs. 11.8%; log-rank p < 0.001). In particular, the incidence of death was higher in the replacement versus repair group (21.9% vs. 4.5%; p < 0.001), while the incidence of reintervention was comparable between groups (8.2% vs. 5.1%; p = 0.16). AR ≥ grade 2 (mild-to-moderate) at discharge (2.9%) was more common in repair versus replacement (3.5% vs. 0.3%; p < 0.0001). AR (Grade 2) at discharge was significantly associated with higher incidence of the primary endpoint (adjusted HR: 2.60 [95% CI 1.01–6.74]; p = 0.04). Conclusion Surgical repair was associated with better survival than replacement at mid-term follow-up without increased risk of reoperation. However, the incidence of postoperative AR ≥ grade 2 was higher in repair than in replacement surgery. AR ≥ grade 2 at discharge was a strong predictor for reintervention during follow-up, stressing the importance of achieving complete correction of AR at the time of aortic valve repair.

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Journal
Journal of the Heart Valve Society
Published
2024-10-01
DOI
https://doi.org/10.1177/30494826241300881
Citations
3
Primary Topic
Aortic Disease and Treatment Approaches
Type
article
Field-Weighted Citation Impact
1.26
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article

Mid-term Clinical and Hemodynamic Outcomes in Patients Treated for Aortic Regurgitation and/or Ascending Aorta Aneurysm: The 3-Year Flight of the AVIATOR Registry

Mikita Karalko, Rubina Rosa, Sébastien Hecht, Lionel Tastet et al.
3 citations
Journal of the Heart Valve Society
Aortic Disease and Treatment Approaches
1.26
article

Mid-term Clinical and Hemodynamic Outcomes in Patients Treated for Aortic Regurgitation and/or Ascending Aorta Aneurysm: The 3-Year Flight of the AVIATOR Registry

Mikita Karalko, Rubina Rosa, Sébastien Hecht, Lionel Tastet, Adrián Kolesár, Ilaria Chirichilli, Peter Verbrugghe, Annette Hubsch, Vincent Chauvette, Erwan Salaün, Patrick Yiu, Jolanda Kluin, Jaroslav Hlubocký, Marek Jasiński, Emmanuel Lansac, Christian Dinges, Laurent de Kerchove, Igor Rudež, Aline Laubriet, Fabrizio Ceresa, Frederiek de Heer, Ismaı̈l El-Hamamsy, Philippe Pibarot
article en
3 citations

Abstract

Background There are few prospective and large registries on outcomes after aortic valve repair/sparing or replacement in patients with aortic valve regurgitation (AR), with or without ascending aorta aneurysm. Methods A total of 2,026 patients enrolled prospectively in The Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) were included in this analysis. The primary endpoint was the composite of all-cause death or aortic valve and/or aorta reintervention. Results 1,630 (80%) received surgical repair/sparing versus replacement in 396 (20%). During a mean follow-up of 3.8 ± 1.9 years, 187 (9.2%) events occurred, including 106 reinterventions and 81 deaths. The incidence of the composite endpoint was higher in the replacement versus repair group (25.3% vs. 11.8%; log-rank p < 0.001). In particular, the incidence of death was higher in the replacement versus repair group (21.9% vs. 4.5%; p < 0.001), while the incidence of reintervention was comparable between groups (8.2% vs. 5.1%; p = 0.16). AR ≥ grade 2 (mild-to-moderate) at discharge (2.9%) was more common in repair versus replacement (3.5% vs. 0.3%; p < 0.0001). AR (Grade 2) at discharge was significantly associated with higher incidence of the primary endpoint (adjusted HR: 2.60 [95% CI 1.01–6.74]; p = 0.04). Conclusion Surgical repair was associated with better survival than replacement at mid-term follow-up without increased risk of reoperation. However, the incidence of postoperative AR ≥ grade 2 was higher in repair than in replacement surgery. AR ≥ grade 2 at discharge was a strong predictor for reintervention during follow-up, stressing the importance of achieving complete correction of AR at the time of aortic valve repair.

Journal of the Heart Valve SocietyVol. 1(1)
Cliniques Universitaires Saint-Luc (BE), Charles University (CZ), Paracelsus Medical University (AT), New Cross Hospital (GB), Montreal Heart Institute (CA), University Hospital Dubrava (HR), Erasmus MC (NL), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Wroclaw Medical University (PL), Ospedale Maggiore (IT), Institute Mutualiste Montsouris (FR), Mount Sinai Hospital (US), Institut universitaire de cardiologie et de pneumologie de Québec (CA), Hospital de Cruces (ES), University Hospital Hradec Králové (CZ), Maison des Sciences sociales et des Humanités de Dijon (FR), European Hospital (IT), Amsterdam University Medical Centers (NL), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte (IT), Université Laval (CA), UCLouvain (BE), Icahn School of Medicine at Mount Sinai (US), KU Leuven (BE)
Good health and well-being
Openalex Percentile: Top 17%
Aortic Disease and Treatment Approaches
1.26
DOIOpen Access PDFOpenAlex
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