Freedom from reoperation and aortic insufficiency ≥II
This is the main point of discussion, the AVRec surgery must still demonstrate long-term durability and to have accurate evidence we need comparative studies mainly with mechanical prostheses.
Benedetto et al. realized a meta-analytic comparison between series on AVRec surgery and biological prosthesis (Trifecta, Magna Ease, Freedom Solo, Freestyle, Mitroflow and autograft aortic valve). Meta-analytic estimates showed non-significant difference between AV reconstruction surgery and all but Magna Ease valves with regards to structural valve degeneration, re-intervention and endocarditis. When compared Magna Ease valve, AV reconstruction and other valve substitutes showed an excess of valve-related events.27
In the follow-up, we have not reoperated any patient for valve dysfunction. Survival free of AV insufficiency> II is 91.7% (Figure 2C).
Ozaki et al. report freedom from death, cumulative incidence of reoperation, and that of recurrent moderate aortic regurgitation or greater was 85.9%, 4.2%, and 7.3%, respectively, after a mean follow-up period of 53.7 ± 28.2 months. Reoperations were performed in 15 patients (0.4% per patient-year), in 13 of which the reoperation was due to infective endocarditis. Krane et al. report on 4 patients undergoing reoperation; 2 because of early valve insufficiency, one due to endocarditis 6 weeks postoperatively, and 1 patient due to aortic valve insufficiency 2 years after surgery. Freedom from aortic insufficiency ≥ grade II at 12 and 24 months was 98.2% ± 0.02% and 92.1% ± 0.05%, respectively. Other surgeons report similar results.(18,20-22,27)