Does aortic valve anatomy affect the long-term outcomes of aortic root reimplantation? A retrospective study with propensity score matching

Introduction: The results of aortic root reimplantation techniques in patients with tricuspid aortic valve (TAV) are generally recognized. However, data on the results of valve-preserving operations in patients with bicuspid aortic valve (BAV) remain limited. Objective: In this retrospective study we compare the long-term results of reimplantation technique, depending on the type of aortic valve (AV): BAV versus TAV. Methods: The retrospective study included 224 patients (average age 48.43 ± 13.70 years, 81.2% men) who underwent valve-preserving operations by reimplantation of the aortic root from January 2013 to January 2023. Depending on the anatomical variant of the AV, the entire sample was divided into two groups: 76 patients with BAV (33.9%) and 148 patients with TAV (66.1%). To eliminate the systematic differences between the compared groups, the propensity score matching (PSM) analysis was used in order to compare groups by 12 criteria. As a result, 33 pairs of patients were formed. After the PSM analysis, there were no significant differences between the groups. Results: In total, 221 (98.2%) patients were examined in the long-term period. The average follow-up period for the entire sample was 53.17 ± 26.34 months. After the PSM analysis, there were no significant differences between the groups in the number of patients examined, namely 33 individuals (100%) in each group. The average follow-up period was 55.24 ± 22.66 months. At long-term follow-up, 100% survival was recorded in both groups. Prior to the PSM analysis, the freedom from aortic insufficiency (AI) grade ≥ II in the patients with TAV was 90.2% and 88.2% at 5 and 10 year follow-up periods, and in patients with BAV this indicator was 89.6% and 89.6% (p = 0.786), respectively. After the PSM analysis, the freedom from AI grade ≥ II in the patients with TAV was 84.2% and 84.2% at 5 and 8 year follow-up periods, and in the group with BAV it was 85.1% and 85.1% (p = 1.000), respectively. Prior to the PSM analysis, freedom from aortic valve reoperation at 5 and 10 year follow-up periods in the patients with TAV was 99.3%, and in the patients with BAV it was 98.6% (p = 1.000). After the PSM analysis, this indicator at 5 and 8 year follow-up periods in the patients with TAV and with BAV was 100% and 96.7%, respectively (p = 1.000). Conclusion: The reimplantation technique enables to effectively reconstruct the aortic root regardless of the anatomical variant of the AV, providing excellent survival with a low risk of reoperation.