Impact of annulus-cusp mismatch on mid-term outcomes of aortic valve repair with valve-sparing aortic root replacement.

Objectives: This study aimed to investigate mid-term outcomes of aortic valve repair with valve-sparing aortic root replacement based on different grades of annulus-cusp mismatch and identify optimal aortic root geometries for this procedure.

Methods: A retrospective analysis was conducted between October 2011 and July 2022. Patients were stratified into three groups based on predicted coaptation length calculated using an annulus-cusp mismatch formula: no-mismatch (coaptation length > 4 mm, n = 52), mild-mismatch (2 mm ≤ coaptation length ≤ 4 mm, n = 28) and severe-mismatch (coaptation length < 2 mm, n = 25), and mid-term outcomes were compared.

Results: We included 105 patients who underwent valve-sparing root replacement using the reimplantation technique. During the median follow-up of 6.0 years, 21 moderate aortic valve regurgitation events and 6 reoperation events were observed. No significant inter-group differences in overall survival or cumulative incidence of cardiac death or hospitalization for heart failure were observed. However, the groups significantly differed in the cumulative incidence of moderate aortic regurgitation at 5 years (2.0%, 14.8% and 60.1% for no-mismatch, mild-mismatch and severe-mismatch groups, respectively; P < 0.001) and cumulative incidence of reoperation at 5 years (0%, 0% and 11.8%, respectively; P = 0.002).

Conclusions: Our findings suggest that severe annulus-cusp mismatch is associated with higher rates of valve regurgitation and reoperation following aortic valve repair with valve-sparing aortic root replacement; however, larger studies are needed for confirmation. Preoperative computed tomography-based assessment of annulus-cusp mismatch shows promise in surgical planning and patient selection for aortic valve repair procedures.

Clinical registration number: 4392.