Moderate or severe aortic valve disease in patients with successful rheumatic mitral and tricuspid valve repair: Efforts to repair valve

Figures

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  Rheumatic AV repair can alleviate lesion severity in selected patients.

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  Figure 1. Surgical techniques used in AV repair. Techniques were selected based on lesion characteristics and often combined intraoperatively. AV, Aortic valve.

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  Figure 2. Grading of valve lesions before surgery, after surgery, and at last follow-up. MS, Mitral stenosis; MR, mitral regurgitation; TR, tricuspid regurgitation; AS, aortic stenosis; AR, aortic regurgitation; AVR, aortic valve replacement; AVP, aortic valve plasty (repair).

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  Figure 3. Kaplan-Meier curves comparing long-term outcomes between AV replacement and AV repair groups, before and after inverse probability of treatment weighting (IPTW). A-C, unadjusted curves; D-F, IPTW-adjusted curves. All curves represent 95% CIs for the time-varying outcomes. AV, Aortic valve.

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  Figure 4. Moderate or severe aortic valve disease in patients with successful rheumatic mitral and tricuspid valve repair: efforts to repair valve.

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  Figure E1. Number of patients completing echocardiographic follow-up at scheduled time points, by surgical group.

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  Figure E2. Standardized mean differences (SMDs) before and after inverse probability weighting (IPW) for baseline covariates. This figure illustrates the balance of baseline characteristics between the aortic valve (AV) repair and AV replacement groups before and after inverse probability of treatment weighting (IPTW). Each point represents the SMD for 1 of the 17 covariates included in the propensity score model. Red triangles indicate unweighted SMDs, and blue circles indicate SMDs after IPTW adjustment. The vertical dashed red line at 0.1 denotes the commonly accepted threshold for adequate covariate balance. After IPTW, all covariates achieved an SMD below 0.1, suggesting successful balancing of baseline differences between treatment groups. NYHA, New York Heart Association.

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  Figure E3. Fine-Gray competing risk curves for valve-related adverse events between aortic valve (AV) replacement and AV repair groups, with “death” as competing event. A-C, Unadjusted curves; D-F, inverse probability of treatment weighting (IPTW)-adjusted curves. All curves represent 95% CIs for the time-varying outcomes. MV, Mitral valve; TV, tricuspid valve.

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  Figure E4. Kaplan-Meier curves for freedom from severe mitral/tricuspid valve (MV/TV) adverse events before and after inverse probability weighting (IPW). All curves represent 95% CIs for the time-varying outcomes. A, unadjusted curves; B, inverse probability of treatment weighting (IPTW)-adjusted curves. AV, Aortic valve.

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  Figure E5. Illustration of aortic valve repair techniques based on aortic valve lesion characteristics. This figure shows a series of images demonstrating different repair techniques employed based on the characteristics of aortic valve lesions, including the handling of fibrotic tissue, commissurotomy, and leaflet decalcification, in order to optimize valve function and reduce residual regurgitation, aiming for the best-possible outcome.