General thoracic and cardiovascular surgery · 2026
Neocuspidization versus bioprosthesis in surgical replacement of the aortic valve: a propensity-matched comparative analysis of immediate and mid-term outcomes.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mokryk Igor, Nechai Illia, Stetsiuk Ihor, Mourtarakos Alexandros, Todurov Mykhailo, Demyanchuk Vitaly, Todurov Borys
Аннотация
OBJECTIVES: This study aims to compare the immediate and mid-term outcomes of Aortic Valve Neocuspidization (AVNeo) with surgical aortic valve replacement using a bioprosthesis (BioSAVR) to determine if neocuspidization can overcome limitations of current techniques.
METHODS: From December 2016 to December 2023, 155 patients received AVNeo at the Heart Institute, while 301 underwent BioSAVR. Baseline characteristics were balanced using 1:1 propensity matching.
RESULTS: 132 identical patient pairs were included in the analysis. Neocuspidization had longer ischemic times (98.67 ± 28.47 min vs. 66.76 ± 25.04 min, ρ < 0.001). Permanent pacemaker implantation (ρ = 0.072) and paravalvular leaks (ρ = 0.041) were more common in the BioSAVR group. Follow-up averaged 43.8 ± 27.30 months. Severe post-procedural aortic stenosis (PPAS) was more frequent after BioSAVR (3 (2.8%) vs. 1 (0.9%), ρ = 0.006), but AVNeo experienced more recurrent severe aortic regurgitation (AR) (3 (2.8%) vs. 0, ρ = 0.035). Reoperation rates were similar (AVNeo 3.1%, BioSAVR 1.5%, ρ = 0.680). Prosthetic valve endocarditis (PVE) was responsible for half (2 cases) of the AVNeo reoperations. Survival rate during follow-up was comparable: 92.8% (AVNeo) and 94.4% (BioSAVR), ρ = 0.672.
CONCLUSIONS: Immediate and mid-term AVNeo quality outcomes were comparable to those of BioSAVR. Transvalvular hemodynamics were better, and the incidence of PPAS was lower after AVNeo, supporting the recommendation of this procedure for patients at high risk of patient-prosthesis mismatch. During follow-up, AVNeo patients require close monitoring for recurrent AR and aggressive PVE prophylaxis. A multicenter long-term study is needed to confirm the stability of hemodynamic performance, the rate of Structural Valve Deterioration, and the incidence of PVE in AVNeo patients over the long term.
METHODS: From December 2016 to December 2023, 155 patients received AVNeo at the Heart Institute, while 301 underwent BioSAVR. Baseline characteristics were balanced using 1:1 propensity matching.
RESULTS: 132 identical patient pairs were included in the analysis. Neocuspidization had longer ischemic times (98.67 ± 28.47 min vs. 66.76 ± 25.04 min, ρ < 0.001). Permanent pacemaker implantation (ρ = 0.072) and paravalvular leaks (ρ = 0.041) were more common in the BioSAVR group. Follow-up averaged 43.8 ± 27.30 months. Severe post-procedural aortic stenosis (PPAS) was more frequent after BioSAVR (3 (2.8%) vs. 1 (0.9%), ρ = 0.006), but AVNeo experienced more recurrent severe aortic regurgitation (AR) (3 (2.8%) vs. 0, ρ = 0.035). Reoperation rates were similar (AVNeo 3.1%, BioSAVR 1.5%, ρ = 0.680). Prosthetic valve endocarditis (PVE) was responsible for half (2 cases) of the AVNeo reoperations. Survival rate during follow-up was comparable: 92.8% (AVNeo) and 94.4% (BioSAVR), ρ = 0.672.
CONCLUSIONS: Immediate and mid-term AVNeo quality outcomes were comparable to those of BioSAVR. Transvalvular hemodynamics were better, and the incidence of PPAS was lower after AVNeo, supporting the recommendation of this procedure for patients at high risk of patient-prosthesis mismatch. During follow-up, AVNeo patients require close monitoring for recurrent AR and aggressive PVE prophylaxis. A multicenter long-term study is needed to confirm the stability of hemodynamic performance, the rate of Structural Valve Deterioration, and the incidence of PVE in AVNeo patients over the long term.