Matched comparison between external aortic root support and valve-sparing root replacement

Abstract

ObjectivesDifferences in indication and technique make a randomised comparison between valve-sparing root replacement (VSRR) and personalised external aortic root support (PEARS) challenging. We performed a propensity score (PS)-matched comparison of PEARS and VSRR for syndromic root aneurysm.MethodsPatients in the PEARS 200 Database and Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (undergoing VSRR) with connective tissue disease operated electively for root aneurysm <60 mm with aortic regurgitation (AR) <1/4 were included. Using a PS analysis, 80 patients in each cohort were matched. Survival, freedom from reintervention and from AR ≥2/4 were estimated using a Kaplan-Meier analysis.ResultsMedian follow-up was 25 and 55 months for 159 PEARS and 142 VSRR patients. Seven (4.4%) patients undergoing PEARS required an intervention for coronary injury or impingement, resulting in one death (0.6%). After VSRR, there were no early deaths, 10 (7%) reinterventions for bleeding and 1 coronary intervention. Survival for matched cohorts at 5 years was similar (PEARS 98% vs VSRR 99%, p=0.99). There was no difference in freedom from valve or ascending aortic/arch reintervention between matched groups. Freedom from AR ≥2/4 at 5 years in the matched cohorts was 97% for PEARS vs 92% for VSRR (p=0.55). There were no type A dissections.ConclusionsVSRR and PEARS offer favourable mid-term survival, freedom from reintervention and preservation of valve function. Both treatments deserve their place in the surgical repertoire, depending on a patient’s disease stage. This study is limited by its retrospective nature and different follow-ups in both cohorts.

Correspondence on “Has personalised surgery made another advancement in aortic root surgery?” by Zhu and Woo

“…We consider that the intention of early diagnosis and monitoring of congenitally determined aortic root disease is to offer truly prophylactic interventions. As set out in the editorial, VSRR is more versatile than PEARS2 but stability of aortic dimension and aortic valve function were comparable in the propensity-matched comparison 1. In the survey of patients’ values,6 most placed high value on the reduced burden of anxiety and freedom to enjoy an unrestricted active lifestyle.…”

“…To the Editor A matched comparison of personalised external aortic root support (PEARS) and valve-sparing root replacement (VSRR)—to which two of the present authors contributed (JP, TT)—has recently been published 1. In an accompanying editorial, Zhu and Woo ask whether PEARS is an advancement in aortic root surgery 2.…”

Has personalised surgery made another advancement in aortic root surgery?

“…In this issue’s matched comparison of PEARS versus VSARR conducted by Van Hoof et al ,8 the authors investigated patients in the “PEARS 200” database and patients in the “Aortic Valve Insufficiency and Ascending Aorta Aneurysm International Registry” who underwent VSARR. Only patients with connective tissue disease operated electively for root aneurysm <60 mm with AR of <1/4 were included.…”

Aortic Valve Repair and Early-Career Surgeons—Nothing Is Impossible

“…However, this is changing as we speak. With their investigation of aortic valve repair in patients with connective tissue disease operated electively for root aneurysm < 60 mm with aortic regurgitation (AR) < 1/4, Van Hoof and colleagues [10] inform us that we should perform AV repair in these patients. In their analysis of 80 patients published in Heart, 5-year survival reached 99% with no Stanford type A dissections and 92% freedom from significant postoperative aortic regurgitation.…”