Surgery of the aortic root: Should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

Abstract

ObjectiveTo compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graftvalve replacement.MethodsFrom January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.ResultsIn-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation.ConclusionThe aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

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

“…Valve sparing aortic root replacement (VSRR) surgery is one of the key methods of intervention for the treatment of pathologies affecting the aortic root and the aortic valve (AV). 1 Pathologies such as connective tissues defects seen in Marfan syndrome; secondary atherosclerotic degeneration; congenital anomalies within the AV; acute infective endocarditis; and rheumatic heart disease can all lead to life-threatening sequelae such as progressive aortic dilatation and can later progress to severe aortic regurgitation which often requires immediate surgical intervention. 2 It was in the early 1990s that two mainstay techniques came into practice 3 ; David's valve-sparing aortic root reimplantation 4…”

Short-term results of flanged Bentall de Bono and valvesparing David V procedures for the treatment of aortic root aneurysms

“…In the same study, they noticed that bleeding (requiring re-exploration) was lower in the valve-sparing group and they associated the higher mortality rate in the composite valve graft group with early and late-term complications related to bleeding. Additionally, there were significant differences between the groups in terms of thromboembolic events in that study 9…”

“…In a recent study, Lamana et al9 analysed 324 patients, of whom 263 had undergone mechanical composite valve graft surgery and 61 valve-sparing root surgery. They observed that there were no statistically significant differences in short-term mortality rates (p = 0.71), but the long-term mortality rate was lower in the valve-sparing group (p = 0.001).…”

Influence of Bentall Procedure on Left Ventricular Function

“…However, no difference was found in terms of ventricular function and LV end-diastolic volume between these techniques. The mortality rate of patients with mechanical valve was found to be higher at the 10-year follow-up period, although there was no difference in mortality in their 5-year follow-up [26,29] .…”