Outcomes in techniques of valve sparing aortic root replacement: A systematic review and meta‐analysis

Abstract

Objective: To compare clinical outcomes of reimplantation versus remodeling in patients undergoing valve-sparing aortic root replacement (VSRR) surgery. Method: Electronic database search at PubMed, Scopus, Embase, Ovid, and Google scholar was performed from inception to January 2020. Primary outcomes were aortic valve (AV) reintervention and postoperative grade of aortic insufficiency (AI) while secondary outcomes were 30-day mortality, reoperation for bleeding, and operative times. Results: A total of 21 articles met the inclusion criteria. A total of 1283 patients had reimplantation while 1150 had remodeling. No difference in preoperative demographics was noted except reimplantation patients were younger (48 ± 16 vs. 56 ± 15 years; p < .00001). The cardiopulmonary bypass and aortic cross-clamp times were shorter in the remodeling cohort (168 ± 38 vs. 150 ± 37 min; p = .0001 and 133 ± 31 vs. 112 ± 30 min; p = .0002, respectively). No difference in concomitant total arch surgery (14% in reimplantation vs. 15% in remodeling; p = .53). Postoperatively, there were similar stroke rates (3% in both cohorts; p = .54), rates of reoperation for bleeding (9% in reimplantation vs. 12% in remodeling; p = .88), and 30-day mortality (3% in reimplantation vs. 4% in remodeling; p = .96). No difference in early AV reintervention (1% in reimplantation vs. 2% in remodeling; p = .07), and late AV reintervention (4% in reimplantation vs. 7% in remodeling; p = .07). The AI of +2 grade was significantly lower in the reimplantation cohort (5% vs. 8%; p = .01). Conclusion: Our study shows comparable clinical outcomes between both techniques. The practice of each technique is largely center and surgeon dependent. Larger sample size cohorts with minimal confounding factors are required to confirm the above findings.

Preliminary results of a simplified aortic valve‐sparing technique: A feasibility study

“…First, the incidence of new‐onset of permanent stroke reported in the literature during reimplantation technique ranging from 1% to 3%. In this context, our results by using SVST showed an incidence of stroke of 2.5%, and this is perfectly in line with those previously published 12,13 …”

“…In this context, our results by using SVST showed an incidence of stroke of 2.5%, and this is perfectly in line with those previously published. 12,13 The same goes for the incidence of permanent pacemaker implantation and myocardial infarction, in our series of 0.8% for both.…”

“…Second, 2 recently published metanalysis 12,13 report early mortality after reimplantation technique of about 2.2‐3%. In our series here proposed, the 30‐day mortality was 0.83% (one patient) and only one patient died during the follow‐up period.…”

Fifteen‐year experience with the Tirone David procedure in bicuspid aortic valve: A safe option

“…For three decades, both approaches have yielded good results, including good long-term outcomes in the case of tricuspid aortic valves. 8,11,15 However, our center has preferred the Tirone procedure because it provides a complete stabilization of the root, including the annulus. After Modine et al described a modified technique using a single inflow suture line, we adopted that, as well.…”

Valve sparing root replacement — Are we limited in our options?

“…Reimplantation, on the contrary, offers stronger annular support but is associated with potentially less favorable hemodynamics and the risk of cusp damage caused by the cusp touching the graft in systole. 4 Toh et al 5 conducted a systematic review and meta-analysis comparing both techniques and concluded no clear superiority of one approach, both providing similar clinical outcomes. There have been several modifications to both techniques since their introduction, which may explain in part why there lies such a narrow difference in outcomes.…”