OBJECTIVES
The study objective is to evaluate outcome of valve-sparing root replacement(VSRR) and its comparison to 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: 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 CVG-ARR patients to 654 VSRR patients (median age, 56.0; median follow-up was 4 years in both, IQR 1–5 years). Early mortality was 1.1% in VSRR versus 2.3% in CVG-ARR. Survival was 95.4% (95% CI 94–97%) at 5 years in VSRR versus 85.4% (95% CI 82–92%) in CVG-ARR, p = 0.002. Freedom from reintervention at 5 years was 96.8% (95% CI 95–98%) in VSRR and 95.4% (95% CI 91–99%) in CVG-ARR, p = 0.98. Additionally, there were more thromboembolism, endocarditis and bleeding events in CVG-ARR (p = 0.02).
CONCLUSIONS
This multicentre study shows excellent results after valve-sparing root replacement in patients with ascending aortic aneurysm with or without valve insufficiency. Compared to composite valve-graft aortic root replacement, survival is better and valve-related event 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 centers.