Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis

Abstract

Background Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). Design Meta-analysis with meta-regression and systematic review. Setting Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. Interventions All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. Result Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. Conclusion The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.

Valve-Sparing Root Replacement: Reimplantation Technique

“…Although this article focuses on repair of a trileaflet aortic valve, repair of a bicuspid aortic valve (BAV) using similar techniques has been shown to have similar outcomes over a 10-year follow-up period. 3 …”

“…Valve-sparing root replacement (VSRR) has been shown to be an effective treatment for aortic root pathology with or without aortic insufficiency (AI) that preserves the patient’s native aortic valve. 1 , 2 , 3 , 4 The 2 VSRR techniques—remodelling (first described by Dr Yacoub in the 1980s) and reimplantation (first described by Dr David in the 1990s) — have evolved and have come to share more similarities over time. 4 In this paper, we describe the nuances of VSRR using the reimplantation technique, along with special perioperative considerations.…”

Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratio

“… 3 Recent studies looking at comparative outcomes of VSARR in patients with BAV and tricuspid aortic valves suggest similar mortality rates but potentially greater early reintervention rates in patients with BAV. 4 , 5 , 6 , 7 Aortic regurgitation is a common indication for reoperation and often occurs in the setting of cusp prolapse or root aneurysm. 6 These studies underscore the need for tailored approaches in patients with BAV and reflect the nuanced technical challenges in managing this patient population.…”