Statistical analysis
All analysis were performed with Stata software version 15. Categorical data were described as absolute and percentage (%) values. Continuous normal distributed variables were expressed as mean ±standard deviation (SD), while continuous not-normal variables were reported as median and [25th percentile; 75th percentile]. To assess normal distribution Shapiro-Wilk test was employed. Kaplan-Meier estimates were used to analyze long-term survival. Cumulative incidence function (CIF) was computed for recurrence of aortic valve regurgitation (≥3+), aortic valve stenosis ( ≥3+), with death as competing risk. Spaghetti plots were used to support visual assessment of the longitudinal trajectory of the degree of Aortic valve regurgitation and Aortic valve stenosis for each individual over time. In particular, a spaghetti plot shows for each patient the values for the repeated outcome measure (aortic valve stenosis and aortic valve regurgitation on vertical axis) versus time (horizontal axis) and connects the dots chronologically, using lines of uniform color and intensity for each subject. A p-value of less than 0.05 was employed to define statistical significance.