A systematic review and meta-analysis of mechanical vs biological composite aortic root replacement, early and 1-year results

Bashir, Mohamad; Harky, Amer; Froghi, Saied; Adams, Benjamin; Garner, Megan; Gupta, Prity; Oo, Aung; Uppal, Rakesh

doi:10.1007/s11748-017-0845-2

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…current era, aortic root replacement surgery attained low early mortality, low postoperative stroke rates, and acceptable long-term survival. A few recent systematic reviews and meta-analyses demonstrated no statistical difference in short-and mid-term outcomes between biological and mechanical valve conduits for aortic root replacement; however, there remain missing data in terms of current valves long-term data, particularly with regard to reoperation rates, considering tissue conduits are not life long lasting (4,5).…”

Section: Original Article On Cardiac Surgerymentioning

confidence: 99%

The evidence in a Bentall procedure with Valsalva graft: is this standard of care?

et al. 2018

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Section: Original Article On Cardiac Surgerymentioning

confidence: 99%

The evidence in a Bentall procedure with Valsalva graft: is this standard of care?

et al. 2018

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“…Available evidences have demonstrated that stentless valves are being more durable, contributed by the lower likelihood of calcifying, which is proven in experimental studies, 44 and requiring a lower incidence of reoperation beyond 5 years. 17,23,33,[45][46][47][48][49][50] This could be applicable to small aortic root patients, but a conclusion could not be drawn until studies of longer terms are reported.…”

Section: Hemodynamic Resultsmentioning

confidence: 99%

Stented versus Stentless Aortic Valve Replacement in Patients with Small Aortic Root

Harky

Wong

Hof

et al. 2018

Innovations�(Phila)

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Objective The aim of the study was to compare hemodynamic and perioperative outcomes of stented against stentless aortic valve replacement in patients with small aortic root (21 mm or less). Methods A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in small aortic root patients. Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analyzed. Results A total of seven studies with a total of 965 patients fulfilled the inclusion criteria. There was no significant difference in preoperative baselines including mean age between both groups ( P = 0.08), peak aortic valve gradient ( P = 0.06), and effective orifice area ( P = 0.28), whereas higher mean aortic valve gradient in the stented group ( P = 0.007). No difference in cardiopulmonary bypass time ( P = 0.74), aortic cross-clamp times ( P = 0.88), intensive care unit stay ( P = 0.13), and stroke rate ( P = 0.56) were noted. However, stented group of patients showed higher rate of patient prosthesis mismatch ( P = 0.0001) and longer total hospital stay ( P = 0.002). Postoperatively, stentless group showed lower peak and mean aortic valve gradient ( P = 0.003 and P = 0.008, respectively) with a better effective orifice area ( P < 0.00001) at 6 months of follow-up. Mortality rates while in-hospital and at 1 year were similar in both groups ( P = 0.94 and P = 0.86, respectively). Conclusions Stentless aortic valves offer superior short-term hemodynamic outcomes in patients with small aortic root when compared with stented aortic valves. Although both groups have similar perioperative complications rates, stentless valves bring about a shorter hospital stay. A further large multicenter randomized controlled trial should address the longer-term benefit of stentless aortic valve over stented valve.

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“…Both IA and RAA aid in avoiding retrograde perfusion of the thoracoabdominal aorta and thus reducing the risk of brain embolic and malperfusion . In the comparative studies that used both the RAA and IA, it was demonstrated that major outcomes including in‐hospital mortality, neurological complications, and major organ complications were comparable between the two methods (Table ).…”

Section: Discussionmentioning

confidence: 98%

Innominate artery cannulation in aortic surgery: A systematic review

et al. 2018

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Objective: The innominate artery is considered an alternative site for establishing cardiopulmonary bypass in surgical procedures involving the thoracic aorta. This systematic review examines the use of innominate artery cannulation in aortic surgery.Methods: A systematic literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all studies that utilized innominate artery cannulation for establishing cardiopulmonary bypass and providing cerebral perfusion in thoracic aortic surgery. The data were reviewed up to September 2018.Results: Acute type A aortic dissection contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719) underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending and hemi-arch replacement, while 11.5% had total aortic arch replacement and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111). All-cause 30-day mortality rate was 2.7% (n = 61).Conclusion: Innominate artery cannulation is a safe technique in patients who undergo thoracic aortic surgery. It can be utilized, in selected cases, as a reliable route for establishing cardiopulmonary bypass and maintaining cerebral perfusion. K E Y W O R D S aorta, aortic surgery, cannulation, innominate artery

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A systematic review and meta-analysis of mechanical vs biological composite aortic root replacement, early and 1-year results

Abstract: Composite mechanical root offers no superiority to composite biological root. There is a significant increase in the perioperative bleeding amongst composite mechanical root cohort. There is a need for further randomized control trail to assess the efficacy of either methods.

Cited by 8 publications

References 26 publications

The evidence in a Bentall procedure with Valsalva graft: is this standard of care?

The evidence in a Bentall procedure with Valsalva graft: is this standard of care?

Stented versus Stentless Aortic Valve Replacement in Patients with Small Aortic Root

Innominate artery cannulation in aortic surgery: A systematic review

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