الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
P
atients presenting with aortic valve insufficiency, with or without aortic root aneurysms have traditionally been treated with isolated aortic valve replacement or composite valve and root replacement (Bentall procedure). While the early outcomes following these procedures are excellent, patients incur the cumulative long-term risk of prosthetic valve related complications which include thromboembolism, prosthetic valve endocarditis, structural and non-structural dysfunction requiring reoperation, and in the case of mechanical valves, thein convenience and risks of anticoagulation related hemorrhage.
Frequently, these procedures are performed in young patients in their third, fourth, or fifth decades of life and therefore, the cumulative risks accrued over several decades can be substantial. Some studies have also demonstrated increased risk of late mortality in patients treated with mechanical aortic valves.
Our study aim to systematically compare clinical outcomes between aortic valve repair and replacement in patients with aortic regurgitation
A comprehensive literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing clinical outcomes of aortic valve repair vs replacement. Database searched from inception to 2021
A total of 830 patients were analyzed in five articles. Mean age was similar in both groups of patients (47.2 ± 12.8 vs 48.3 ± 12.7 years, P = 0.83, aortic valve repair and replacement, respectively). The preoperative left ventricular ejection fraction was better in the repair group (56.7% ± 4.8 vs 53.3% ± 4.2, P = 0.005). The rate of moderate-to-severe regurgitation and bicuspid aortic valve were similar in both cohorts (81% vs 78%, P = 0.9 and 58% vs 55%, P = 0.46). The odds of in hospital mortality was lower in aortic repair group 0.34 while the odds of one year mortality was also in favor of Aortic repair group 0.58.
Aortic valve repair offers comparable perioperative outcomes to aortic valve replacement in aortic regurgitation patients at the expense of higher late re-intervention rate. Larger trials with long-term follow-up are required to confirm the long-term benefits of aortic valve repair.
CONCLUSION
O
ver the past two decades, aortic valve repair has matured from a discipline practiced by a few pioneering surgeons to an increasingly accepted alternative to valve replacement in selected patients with AV disease. Much like mitral valve repair, improvements in the understanding of the mechanisms of disease, advances in surgical techniques and longitudinal follow-up studies have all helped to improve outcomes.
Improvements in devices and materials currently being evaluated to facilitate AV repair is expected to further improve repair durability. Perhaps the most important challenge in its more widespread use is the dissemination of the tacit and sometimes complex skills required. Innovative approaches using advanced, patient-specific, modelling of valve anatomy using 3-dimensional echocardiography and virtual surgery to correct valve defects within these models prior to operative intervention may facilitate dissemination of AV repair techniques to a broader population