Clinical and echocardiographic outcomes after aortic valve neocuspidization: insights from a large multicenter cohort

OBJECTIVES: Aortic valve neocuspidization (AVNeo) has gained widespread recognition in clinical practice; however, multicentre data describing its mid-term functional durability in real-world populations remain limited. This study aimed to evaluate the clinical and echocardiographic outcomes of AVNeo in a large multicentre cohort with extended follow-up. METHODS: This retrospective multicentre study included 672 patients who underwent AVNeo at 16 institutions. The study population was characterized by advanced age, small body size, and a substantial burden of comorbidities. Mid-term outcomes included overall survival, freedom from reoperation, and longitudinal echocardiographic performance assessed from discharge through mid-term follow-up. Survival analyses were performed using the Kaplan-Meier method, and temporal echocardiographic changes were evaluated using linear mixed-effects models accounting for repeated measurements and center-level clustering. RESULTS: Early postoperative outcomes demonstrated acceptable procedural safety, with a 30-day mortality of 3.0%. Echocardiographic assessment showed functional optimization during the first postoperative year, while effective orifice area remained stable. Beyond 1 year, transvalvular gradients, peak velocity, valve area, and ventricular function remained stable up to 7 years after surgery. Estimated overall survival was 91.7% at 1 year and 79.5% at 5 years, while freedom from reoperation remained high at 99.4% at 1 year and 96.5% at 5 years. CONCLUSIONS: In this large multicentre real-world cohort, AVNeo demonstrated stable mid-term valve performance without evidence of clinically significant progressive deterioration. These findings support the durability and reproducibility of AVNeo in routine clinical practice.