Article Text
Abstract
Aortic valve repair is still emerging, and its role in the treatment of bicuspid aortic valve disease (BAVD) is not yet fully understood. Our objective is to synthesise available evidence on outcomes after surgical aortic valve repair in patients with BAVD. We conducted a systematic review of clinical studies using prespecified methods for searching, identifying and selecting eligible studies in 4 databases, and synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers independently reviewed full-text articles and extracted data. The results of included studies were quantitatively synthesised in frequentist meta-analyses. We included 11 aortic valve repair studies or study arms with a total of 2010 participants. Pooled estimates for the proportion of patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995 (95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993) and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean follow-up of 3.5 years. Proportion of patients with valve-related reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9 years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100 patient-years. Outcome reporting was insufficient to pool the results for a number of predefined outcomes. In conclusion, existing evidence on aortic valve repair in BAVD is limited to mostly small case series, case–control and small retrospective cohort studies. Despite the low quality, available evidence suggests favourable survival outcomes after aortic valve repair in selected patients with BAVD. Valve-related reinterventions at follow-up are common in all patients undergoing repair surgery.
- CONGENITAL HEART DISEASE
- Meta-analysis
- aortic valve repair
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Footnotes
Collaborators CARDIOPROOF's partners are the following: Edwin Morley-Fletcher (LYNKEUS), Project Coordinator; Titus Kühne (DHZB), Principal Investigator; Anja Hennemuth (FRAUNHOFER MEVIS); David Manset (GNÚBILA); Alistair McGuire (LSE); Gernot Plank (MUG); Olivier Ecabert (SIEMENS AG); Giacomo Pongiglione (OPBG); Vivek Muthurangu (UCL).
Contributors MS had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. MS, HN, TK and MK were involved in the conception and design of the study. MS and HN selected included studies. MS and SP extracted all data. All authors analysed and interpreted the data. MS conducted statistical analysis. The manuscript was drafted by MS, HN and MK and carefully and critically revised by all authors. All authors have given final approval for the manuscript to be published in its current version.
Funding This work was supported by the European Commission under FP7 (grant number 611232).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.