Comparing outcomes between valve-sparing root replacement and the Bentall procedure in proximal aortic aneurysms: systematic review and meta-analysis. (28th August 2019)

• Record Type: Journal Article
• Authors: Salmasi, Mohammad Yousuf; Theodoulou, Iakovos; Iyer, Priyanka; Al-Zubaidy, Mohaimen; Naqvi, Danial; Snober, Mohammed; Oo, Aung; Athanasiou, Thanos
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 29:Number 6(2019)
• Page Start: 911
• Page End: 922
• Publication Date: 2019-08-28
• Subjects: Aortic dissection -- Aortic root -- Aortic root replacement; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivz211
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: In aortic root aneurysms, the challenge of a valve-sparing aortic root replacement (VSRR) procedure is to ensure durable aortic valve function without reintervention. Although the Bentall procedure defers the durability of valve function to the prosthesis, short- and long-term complications tend to be higher. The aim of this study was to compare the outcomes of VSRR and Bentall procedures in patients with aortic root aneurysms. A systematic literature review was conducted using PubMed regarding the outcomes of the Bentall procedure compared with those of VSRR from the inception of the 2 procedures until July 2018. Studies with short- and long-term comparative data were included. An initial search yielded 9517 titles. Thirty-four studies were finally included for meta-analysis (all retrospective, non-randomized), comprising 7313 patients (2944 valve-sparing and 4369 Bentall procedures) with no evidence of publication bias. Operative mortality was found to be significantly lower in the VSRR group [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37–0.70; P < 0.001] despite overall higher cardiopulmonary bypass and aortic cross-clamp times. The 5-year survival rate was also more favourable in the VSRR group (OR 1.93 95% CI 1.15–3.23; P < 0.05). Significantly lower rates of cerebral thromboembolism (OR 0.668, 95% CI 0.477–0.935; P = 0.019) and heart block (OR 0.386, 95% CI 0.195–0.767; P = 0.007) were also found after VSRR. There was no significant difference in rates of reoperation between the groups at long-term follow-up (OR 1.32, 95% CI 0.75–2.33; P = 0.336). Meta-regression of patient and operative covariates yielded no influence on the main outcomes ( P > 0.05). These findings suggest that VSRR is an appropriate and potentially better treatment option for a root aneurysm when the aortic valve is repairable.