Clinical and echocardiographic outcomes after aortic valve neocuspidization: insights from a large multicenter cohort
Kazuhiro Ueno, Tomoyuki Wada, Toshihiko Shibata, Kazuo Abe, Takashi Murakami, Shigeharu Sawa, Yoshito Inoue, Tamiyuki Obayashi, Kazushige Kanki, Shoichi Takahashi, Shinji MiyamotoAbstract
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.