Long term outcomes
Clinical and echocardiographic follow-up was 100% complete (mean follow-up: 7.4±3.9 years, max 16.4; median 6.8 years [4.5-10.8]). During the follow-up 2 patients died for non-cardiac causes whereas no cardiac deaths occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63] (Fig. 1). Aortic root surgery was not necessary in any patient. Three patients underwent aortic valve replacement. One patient needed reoperation for endocarditis 149 months after the intervention. The others two patients developed severe aortic valve stenosis: one underwent surgical AVR after 154 months, and the other to transcatheter aortic valve implantation (TAVI), after 84 months. Interestingly, both patients didn’t show any grade of aortic stenosis at the preoperative echocardiography in which only some degree of regurgitation had been detected. None of the 3 patients with moderate aortic stenosis at baseline did require aortic valve replacement for significant disease progression. At 12 years the CIF of reoperation with death as competing risk was 2.6 ±2.5%, 95% CI [0.20-11.53] (Fig. 2). At the echocardiographic follow up the median EF was 55 [55-60], aortic regurgitation 3+/4+ was present in 1 patient and aortic stenosis greater than moderate in 3 (Fig. 3,4). At 12 years the CIF of aortic regurgitation >2+/4+ was 5.1±4.98% and of aortic stenosis >moderate 6.9±3.8% (Fig. 5).