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Background Aortic valve repair in rheumatic patients is not well-studied. We aimed to present our initial Egyptian experience in the aortic valve repair and compare it with the aortic valve replacement. The study included 85 patients who had an aortic valve surgery for aortic regurgitation (AR) in a single center from 2018 to 2020. We assigned the patients to either aortic valve repair ( n = 39) or aortic valve replacement ( n = 46). Fifty-nine patients (69.4%) had rheumatic heart disease. Study outcomes were hospital complications and the degree of aortic regurgitation after 6 months in patients who had aortic valve repair. Results Patients who had replacement were significantly older (49.6± 7.2 vs. 43.8± 8.6 years:  P = 0.002) and had more advanced New York Heart Association ( P &lt;0.001) and Canadian Cardiovascular Scoring ( P = 0.03) classes. Hypertension (31 (67.4%) vs. 17 (43.6%);  P = 0.03) and hypercholesteremia (18 (40%) vs. 17 (18.9%);  P = 0.04) were more common in the replacement group. Patients who had replacement had a significantly higher percentage of valve retraction ( P &lt;0.001). Cardiopulmonary bypass (54.5 (49.5–60) vs. 45 (41–49) min;  P &lt;0.001) and ischemic times (36.5 (31–40) vs. 30 (28–33) min;  P &lt;0.001) were longer in patients who had an aortic valve replacement. Blood transfusion (28 (60.9%) vs. 11 (282%);  P = 0.003) and ICU stay (24.5 (24–48) vs 23 (20–31) h;  P = 0.01) were higher in the replacement group. Hospital mortality was non-significantly different between groups. Four patients had trivial AR (10.3%), and six had mild AR (15.4%) in the repair group. There was no difference in valve pathology or outcomes in aortic valve repair patients for degenerative versus rheumatic pathologies. After a 6-month follow-up, four patients had trivial AR (10.3%), and six patients had mild AR (15.4%) in the repair group. Conclusions Aortic valve repair could be an alternative to replacement in selected patients with rheumatic heart disease. Shorter cardiopulmonary bypass and ischemic times may improve repair outcomes compared to replacement.

Early outcomes of aortic valve repair versus replacement for aortic regurgitation: a single-center experience