Regurgitant Bicuspid Aortopathy: Is Valve-Sparing Root Replacement Equivalent to Bentall Procedure?

Kalra, Kanika; Wagh, Kaustubh; Wei, Junhao; McPherson, LaRonica; Binongo, José; Leshnower, Bradley G.; Chen, Edward P.

doi:10.1016/j.athoracsur.2020.08.074

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…The operative mortality and respective morbidity rates were acceptably low in both groups and comparable with other studies. 13,[16][17][18] Our present study showed significantly better survival rates for David group patients (p = 0.04) comparing with Bentall group patients at 10 years and other recent reports. 16,17 Ouzounian et al 17 presented the longest term comparative outcomes to date of 616 patients, comparing AVSRR group (n = 253) to CVG mechanical and biological groups (n = 183; n = 180).…”

Section: Discussionsupporting

confidence: 74%

“…12 Current literature data suggest that young patients with composite valve root substitutes and life-long anticoagulation treatments are prone to the invariably associated risk of cumulative composite events, therefore, AV sparing repair surgery should be considered and performed as a comparable alternative. 13,14 Indeed, from the very beginning with the AV sparing repair surgery programme, we favoured more aggressive reimplantation technique concept 8 over the other AV sparing techniques (i.e. Yacoub-remodeling or Cabrol annuloplasty) in order to downsize and stabilise ventriculoaortic junction (circumferential annuloplasty).…”

Section: Discussionmentioning

confidence: 99%

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Surgical dilemma – spare or replace regurgitant aortic valve: Late comparative outcomes of two strategies

et al. 2022

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Background To evaluate different aortic root surgery techniques and their contemporary clinical outcomes in patients with regurgitant aortic valve and aortic root aneurysm. Methods The study consisted of 141 adult patients who underwent aortic valve reimplantation (David group = 73) or aortic valve replacement surgery (Bentall group = 68) for aortic valve regurgitation (AR) and dilatation of the aortic root at our institution within the same period (April 2004–October 2016). Kaplan–Meier method was used to estimate survival and other clinically relevant outcomes between the groups. Results The completeness of clinical follow-up was 100%, with a mean time of 8.0 ± 3.8 years. Thirty-day (in-hospital) mortality rates were equivalent between groups (1.3 and 1.5%, p = 1.0). The overall survival rates at 10 years were significantly better for the David group patients comparing to Bentall group patients (95.3 ± 2.6% vs 79.7 ± 6.8%; p = 0.04) with similar freedom from AV related reoperation (94.4 ± 2.7% vs 98.5 ± 1.5%; p = 0.2). Freedom from bleeding events at 10 years was 90.7 ± 3.6% for Bentall group patients and none were observed among David group patients ( p = 0.01). Conclusions Aortic valve and root surgery can be performed with equivalent safety and efficacy using either valve-sparing (David procedure) or valve-replacing (Bentall procedure) techniques in selected patients. Furthermore, patients after the David procedure demonstrated significantly improved survival and low risk of bleeding in comparison to the Bentall procedure with an acceptable risk of reoperation at 10 years follow-up.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Surgical dilemma – spare or replace regurgitant aortic valve: Late comparative outcomes of two strategies

et al. 2022

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“…The selection procedure of this systematic review is shown in Figure 1. A total number of 44 studies matched with the inclusion and exclusion criteria and were included for analysis, of which 11 publications separately reported (partially) outcomes on TAV (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and 12 publications on BAV (7,17,20,21,(25)(26)(27)(28)(29)(30)(31)(32). The full list of studies included in this review is presented in the Supplementary material (Appendix 3).…”

Section: Resultsmentioning

confidence: 99%

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Mastrobuoni,

Govers,

Veen

et al. 2023

Ann Cardiothorac Surg

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Background Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. Methods We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. Results Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. Conclusions This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs.

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“…The most common reason was cusp prolapse, and aortic regurgitation from root aneurysm was noted in 15% of the cases [ 28 ]. Most recently, Kalra et al illustrated the safety and usefulness of VSARR in patients with BAV deformity [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies showed comparable findings between VSARR and Bentall procedure with a bioprosthesis [ 29 , 36 ]. Dr. Kalra et al reported an equivalent 10-year reintervention incidence in patients with BAV who underwent VSARR or Bentall procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Zuo

Tan

Qin

2023

J Cardiothorac Surg

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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.

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Regurgitant Bicuspid Aortopathy: Is Valve-Sparing Root Replacement Equivalent to Bentall Procedure?

Cited by 6 publications

References 28 publications

Surgical dilemma – spare or replace regurgitant aortic valve: Late comparative outcomes of two strategies

Surgical dilemma – spare or replace regurgitant aortic valve: Late comparative outcomes of two strategies

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

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

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