• El MathariSulaymanSDepartment of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands. Electronic address: s.elmathari@amsterdamumc.nl., Noor Boulidam, Frederiek de Heer, Laurent de Kerchove, Hans-Joachim Schäfers, Emmanuel Lansac, TwiskJos W RJWRDepartment of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands., Jolanda Kluin, and Aortic Valve Research Network Investigators.
• Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands. Electronic address: s.elmathari@amsterdamumc.nl.
• J. Thorac. Cardiovasc. Surg. 2023 Dec 1; 166 (6): 16271634.e31627-1634.e3.

ObjectivesWe investigated the predictive value of aortic valve cusp retraction, calcification, and fenestration for aortic valvuloplasty feasibility.MethodsMulticenter data were collected for 2082 patients who underwent surgical aortic valvuloplasty or aortic valve replacement. The study population had retraction, calcification, or fenestration in at least one aortic valve cusp. Controls had normal or prolapsed cusps.ResultsAll cusp characteristics demonstrated significantly increased odds ratios [ORs] for switch to valve replacement. This effect was strongest for cusp retraction, followed by calcification and fenestration (OR, 25.14; P ≤ .001; OR, 13.50, P ≤ .001; OR, 12.32, P ≤ .001). Calcification and retraction displayed increased odds for developing grade 4 aortic regurgitation compared with grade 0 or 1 combined on average over time (OR, 6.67; P ≤ .001; OR, 4.13; P = .038). Patients with cusp retraction showed increased risk for reintervention at 1- and 2-year follow-up after aortic valvuloplasty (hazard ratio, 5.66; P ≤ .001; hazard ratio, 3.22, P = .007). Cusp fenestration was the only group showing neither an increased risk of postoperative severe aortic regurgitation (P = .57) or early reintervention (P = .88) compared with the control group.ConclusionsAortic valve cusp retraction, calcification, and fenestration were all related to increased rates of switch to valve replacement. Calcification and retraction were associated with recurrence of severe aortic regurgitation. Retraction was related to early reintervention. Fenestration was neither associated with recurrence of severe aortic regurgitation or reintervention. This indicates that surgeons are well able to distinguish aortic valve repair candidates in patients with cusp fenestration.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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