A multicentre, propensity score matched analysis comparing a valve-sparing approach to valve replacement in aortic root aneurysm: Insight from the AVIATOR database. (29th October 2022)

• Record Type: Journal Article
• Authors: Arabkhani, Bardia; Klautz, Robert J M; de Heer, Frederiek; De Kerchove, Laurent; El Khoury, Gebrine; Lansac, Emmanuel; Schäfers, Hans-Joachim; El-Hamamsy, Ismail; Lenoir, Marien; Aramendi, José I; Meuris, Bart; Verbrugghe, Peter; Kluin, Jolanda; Koolbergen, Dave R; Bouchot, Olivier; Rudez, Igor; Kolesar, Adrian; van Brakel, Thomas J
• Is Part Of: European journal of cardio-thoracic surgery. Volume 63:Number 2(2023)
• Publication Date: 2022-10-29
• Subjects: Valve-sparing root replacement -- aortic valve-repair -- Bentall; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac514
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Our goal was to evaluate the outcome of valve-sparing root replacement (VSRR) and to compare the outcomes to those of patients having composite valve–graft conduit aortic root replacement (CVG-ARR) in a cohort of patients with aortic root aneurysm ± valve insufficiency, without valvular stenosis. Although valve-sparing procedures are preferable in young patients, there is a lack of comparative data in comparable patients. METHODS: The VSRR procedures were performed in 2005 patients, and 218 patients underwent a CVG-ARR procedure. Exclusion criteria included aortic dissection, endocarditis and valvular stenosis. Propensity score matching (3:1 ratio) was applied to compare VSRR (reimplantation 33% and remodelling 67%) and CVG-ARR. RESULTS: We matched 218 patients with CVG-ARR to 654 patients with VSRR (median age, 56.0; median follow-up was 4 years in both groups; interquartile range 1–5 years). Early mortality was 1.1% of those who had VSRR versus 2.3% in those who had CVG-ARR. Survival was 95.4% [95% confidence interval (CI) 94–97%] at 5 years in patients who had VSRR versus 85.4% (95% CI 82–92%) in those who had CVG-ARR; P = 0.002. Freedom from reintervention at 5 years was 96.8% (95% CI 95–98%) with VSRR and 95.4% (95% CI 91–99%) with CVG-ARR ( P = 0.98). Additionally, there were more thromboembolic, endocarditis and bleeding events in the patients who had CVG-ARR ( P = 0.02). CONCLUSIONS: This multicentre study shows excellent results after valve-sparing root replacement in patients with an ascending aortic aneurysm with or without valve insufficiency. Compared to composite valve-graft aortic root replacement, survival is better and valve-related events are fewer. Consequently, valve-sparing procedures should be considered whenever a durable repair is feasible. We advocate a valve-sparing strategy even in more complex cases when performed in experienced centres. Abstract : Valve-sparing aortic root surgery is the alternative to valve replacement in patients with aortic root dilatation with or without aortic insufficiency.