Mid-term Clinical and Hemodynamic Outcomes in Patients Treated for Aortic Regurgitation and/or Ascending Aorta Aneurysm: The 3-Year Flight of the AVIATOR Registry

Background There are few prospective and large registries on outcomes after aortic valve repair/sparing or replacement in patients with aortic valve regurgitation (AR), with or without ascending aorta aneurysm. Methods A total of 2,026 patients enrolled prospectively in The Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) were included in this analysis. The primary endpoint was the composite of all-cause death or aortic valve and/or aorta reintervention. Results 1,630 (80%) received surgical repair/sparing versus replacement in 396 (20%). During a mean follow-up of 3.8 ± 1.9 years, 187 (9.2%) events occurred, including 106 reinterventions and 81 deaths. The incidence of the composite endpoint was higher in the replacement versus repair group (25.3% vs. 11.8%; log-rank p < 0.001). In particular, the incidence of death was higher in the replacement versus repair group (21.9% vs. 4.5%; p < 0.001), while the incidence of reintervention was comparable between groups (8.2% vs. 5.1%; p = 0.16). AR ≥ grade 2 (mild-to-moderate) at discharge (2.9%) was more common in repair versus replacement (3.5% vs. 0.3%; p < 0.0001). AR (Grade 2) at discharge was significantly associated with higher incidence of the primary endpoint (adjusted HR: 2.60 [95% CI 1.01–6.74]; p = 0.04). Conclusion Surgical repair was associated with better survival than replacement at mid-term follow-up without increased risk of reoperation. However, the incidence of postoperative AR ≥ grade 2 was higher in repair than in replacement surgery. AR ≥ grade 2 at discharge was a strong predictor for reintervention during follow-up, stressing the importance of achieving complete correction of AR at the time of aortic valve repair.