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Objectives <p>This study aims to compare the immediate and mid-term outcomes of Aortic Valve Neocuspidization (AVNeo) with surgical aortic valve replacement using a bioprosthesis (BioSAVR) to determine if neocuspidization can overcome limitations of current techniques.</p> Methods <p>From December 2016 to December 2023, 155 patients received AVNeo at the Heart Institute, while 301 underwent BioSAVR. Baseline characteristics were balanced using 1:1 propensity matching.</p> Results <p>132 identical patient pairs were included in the analysis. Neocuspidization had longer ischemic times (98.67 ± 28.47&#xa0;min vs. 66.76 ± 25.04&#xa0;min, ρ &lt; 0.001). Permanent pacemaker implantation (ρ = 0.072) and paravalvular leaks (ρ = 0.041) were more common in the BioSAVR group. Follow-up averaged 43.8 ± 27.30&#xa0;months. Severe post-procedural aortic stenosis (PPAS) was more frequent after BioSAVR (3 (2.8%) vs. 1 (0.9%), ρ = 0.006), but AVNeo experienced more recurrent severe aortic regurgitation (AR) (3 (2.8%) vs. 0, ρ = 0.035). Reoperation rates were similar (AVNeo 3.1%, BioSAVR 1.5%, ρ = 0.680). Prosthetic valve endocarditis (PVE) was responsible for half (2 cases) of the AVNeo reoperations. Survival rate during follow-up was comparable: 92.8% (AVNeo) and 94.4% (BioSAVR), ρ = 0.672.</p> Conclusions <p>Immediate and mid-term AVNeo quality outcomes were comparable to those of BioSAVR. Transvalvular hemodynamics were better, and the incidence of PPAS was lower after AVNeo, supporting the recommendation of this procedure for patients at high risk of patient-prosthesis mismatch. During follow-up, AVNeo patients require close monitoring for recurrent AR and aggressive PVE prophylaxis. A multicenter long-term study is needed to confirm the stability of hemodynamic performance, the rate of Structural Valve Deterioration, and the incidence of PVE in AVNeo patients over the long term.</p>

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Neocuspidization versus bioprosthesis in surgical replacement of the aortic valve: a propensity-matched comparative analysis of immediate and mid-term outcomes

  • 期刊论文

  • 发表日期：

    2026年1月13日

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  • Igor Mokryk,
  • Illia Nechai,
  • Ihor Stetsiuk,
  • Alexandros Mourtarakos,
  • Mykhailo Todurov,
  • Vitaly Demyanchuk,
  • Borys Todurov

摘要

Objectives

This study aims to compare the immediate and mid-term outcomes of Aortic Valve Neocuspidization (AVNeo) with surgical aortic valve replacement using a bioprosthesis (BioSAVR) to determine if neocuspidization can overcome limitations of current techniques.

Methods

From December 2016 to December 2023, 155 patients received AVNeo at the Heart Institute, while 301 underwent BioSAVR. Baseline characteristics were balanced using 1:1 propensity matching.

Results

132 identical patient pairs were included in the analysis. Neocuspidization had longer ischemic times (98.67 ± 28.47 min vs. 66.76 ± 25.04 min, ρ < 0.001). Permanent pacemaker implantation (ρ = 0.072) and paravalvular leaks (ρ = 0.041) were more common in the BioSAVR group. Follow-up averaged 43.8 ± 27.30 months. Severe post-procedural aortic stenosis (PPAS) was more frequent after BioSAVR (3 (2.8%) vs. 1 (0.9%), ρ = 0.006), but AVNeo experienced more recurrent severe aortic regurgitation (AR) (3 (2.8%) vs. 0, ρ = 0.035). Reoperation rates were similar (AVNeo 3.1%, BioSAVR 1.5%, ρ = 0.680). Prosthetic valve endocarditis (PVE) was responsible for half (2 cases) of the AVNeo reoperations. Survival rate during follow-up was comparable: 92.8% (AVNeo) and 94.4% (BioSAVR), ρ = 0.672.

Conclusions

Immediate and mid-term AVNeo quality outcomes were comparable to those of BioSAVR. Transvalvular hemodynamics were better, and the incidence of PPAS was lower after AVNeo, supporting the recommendation of this procedure for patients at high risk of patient-prosthesis mismatch. During follow-up, AVNeo patients require close monitoring for recurrent AR and aggressive PVE prophylaxis. A multicenter long-term study is needed to confirm the stability of hemodynamic performance, the rate of Structural Valve Deterioration, and the incidence of PVE in AVNeo patients over the long term.