Outcomes of Aortic Valve Repair: A Systematic Review and Meta-Analysis Using Reconstructed Individual Patient Data

OBJECTIVE: The progressive dissemination of isolated aortic valve repair (AVRep) and valve-sparing root (VSR) procedures has resulted in a cumulative expansion of the available literature. This work aims to synthesize the current knowledge and identify predictors of mortality and reintervention in patients undergoing such valve-preserving procedures. METHODS: A systematic review and meta-analysis were conducted in 2 databases (last search January 2025). Studies with ≥200 adult patients undergoing AVRep or VSR with a minimum mean follow-up ≥5 years were included. Short-term outcomes were summarized using weighted descriptive statistics. Forest plots, funnel plots, and the Newcastle-Ottawa Scale were used to evaluate the risk of bias. Long-term survival and freedom from reoperation were analyzed through reconstructing individual patient data from Kaplan-Meier curves, and a mixed-effects Cox frailty model was used to identify study-level predictors of these endpoints. RESULTS: There were 48 studies included, encompassing 20,914 patients with a mean weighted age of 52.42 (50.28 to 54.57) years. Early outcomes included hospital mortality (1.34% [1.04% to 1.73%]), bleeding (3.77% [2.76% to 5.13%]), myocardial ischemia (0.44% [0.26% to 0.77%]), pacemaker implantation (1.00% [0.63% to 1.59%]), neurologic events (1.27% [0.91% to 1.78%]), and postoperative residual aortic regurgitation (3.48% [1.90% to 6.29%]). Pooled survival at 1, 5, 10, and 20 years of follow-up was 96.8%, 92.5%, 83.8%, and 67%, respectively; freedom from reoperation at the same time points was 97.9%, 93.9%, 88.2%, and 77.5%, respectively. Factors such as older age, female sex, aortic dissection, and isolated valve repair were associated with higher mortality. CONCLUSIONS: These findings suggest that AVRep and VSR are associated with low early mortality and morbidity and excellent long-term outcomes. However, heterogeneity in definitions and endpoints across studies underlines the need for standardized definitions and conduction of properly designed randomized trials.