A multicentre, propensity score matched analysis comparing a valve-sparing approach to valve replacement in aortic root aneurysm: Insight from the AVIATOR database

Arabkhani, Bardia; Klautz, Robert J.M.; Heer, Frederiek de; Kerchove, Laurent de; Khoury, Gébrine El; Lansac, Emmanuel; Schäfers, Hans‐Joachim; El-Hamamsy, Ismaı̈l; Lenoir, Marien; Aramendi, José I.; Meuris, Bart; Verbrugghe, Peter; Kluin, Jolanda; Koolbergen, Dave R.; Bouchot, Olivier; Rudež, Igor; Kolesár, Adrián; Brakel, Thomas J. van

doi:10.1093/ejcts/ezac514

Cited by 8 publications

(5 citation statements)

References 28 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In particular, endocarditis and valve thromboembolism are very rarely reported. This is in line with a recently published, comprehensive propensity score matched study, comparing composite valve-graft replacements to valve-sparing root replacement (1), and in a similar study by Ouzounian et al (41) that showed VSRR procedures were associated with reduced cardiac mortality and valve-related complications.…”

Section: Discussionsupporting

confidence: 90%

“…Valve-sparing aortic root replacement (VSRR) procedures have progressively gained ground in the surgical treatment of aortic root aneurysms with or without aortic regurgitation. Recent comprehensive reports have shown superior outcomes in VSRR compared to composite valve-graft conduit aortic root replacement (i.e., the Bentall or the so called “Bio-Bentall” procedure) in terms of valve-related complications, but also better survival after VSRR is observed ( 1 ). In the current American as well as European guidelines on the management of aortic disease, valve-sparing is preferred over valve replacement, especially in younger patients and when performed in experienced centers.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Mastrobuoni,

Govers,

Veen

et al. 2023

Ann Cardiothorac Surg

Self Cite

View full text Add to dashboard Cite

Background Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. Methods We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. Results Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. Conclusions This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Mastrobuoni,

Govers,

Veen

et al. 2023

Ann Cardiothorac Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent multi-center study (Aviator Registry) demonstrated that valve sparing procedures in patients with aortic root aneurysm with or without aortic regurgitation had excellent mid-term results compared to composite valve replacements ( 25 ). This was also described by the Toronto group, which showed that aortic valve-sparing procedures were associated with reduced cardiac mortality and valve-related complications compared to biologic or mechanical composite graft replacement ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Three decades of reimplantation of the aortic valve—the Brussels Experience

Jahanyar¹,

Kerchove²,

Arabkhani³

et al. 2023

Ann Cardiothorac Surg

Self Cite

View full text Add to dashboard Cite

Background Over the last three decades, the importance of native valve preservation has increasingly become evident. Valve-sparing root replacement procedures, such as the reimplantation or remodeling technique, are therefore being progressively used for aortic root replacement and/or aortic valve repair. Herein, we are summarizing our single-center experience with the reimplantation technique. Methods We queried our prospective database for aortic valve repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacement with the reimplantation technique between March 1998 and January 2022. We subcategorized the patients into three distinct groups: root aneurysm without aortic regurgitation (AR) (grade ≤1+), root aneurysm with AR (grade >1+) and isolated chronic AR (root <45 mm). Univariable logistic regression analysis was performed to identify variables of interest, which were further analyzed by multivariable Cox-regression analysis. Survival, freedom from valve reintervention, and freedom from recurrent regurgitation, were analyzed with the Kaplan-Meier method. Results A total of 652 patients were recruited for this study; 213 patients underwent reimplantation for aortic aneurysm without AR, 289 patients for aortic aneurysm with AR, and 150 patients with isolated AR. Cumulative survival was 95.4% (95% CI: 92.9–97.0%) after 5 years, 84.8% (80.0–88.5%) after 10 years, and 79.5% (73.3–84.5%) after 12 years, which was comparable to the age-matched Belgian population. Older age (HR 1.06, P≤0.001) and male gender (HR 2.1, P=0.02) were associated with late mortality. Freedom from reoperation on the aortic valve at 5 years was 96.2% (95% CI: 93.8–97.7%), and 90.4% (95% CI: 87.4–94.2%) at 12 years. Age (P=0.001) and preoperative left ventricular end-diastolic dimension (LVEDD) (P=0.03) were associated with late reoperation. Conclusions Our long-term data supports our reimplantation approach as a viable option for aortic root aneurysms and/or aortic regurgitation, with long-term survival that mirrors that of the general population.

show abstract

“…Focal calcifications may be removed by enucleation. Hence, with proper patient selection, durable results can be achieved ( 1 ). Younger patients more often present with bicuspid-AV (BAV) and a dilated annulus.…”

Section: Principles For Successful Repairmentioning

confidence: 99%