OBJECTIVES
To examine short- and long-term outcomes of patients with moderate-to-severe aortic insufficiency (AI) undergoing either a Bentall aortic root replacement (ARR) or valve-sparing root replacement (VSRR).
METHODS
A two-center retrospective database of patients undergoing aortic root replacement from 2004 to 2021 was reviewed. Patients <18 years old were excluded. 1527 adult patients underwent Bentall (ARR) (n = 1150, 75%) or VSRR (n = 377, 25%) Propensity-score matching based on preoperative comorbidities was used and 195 matched pairs were identified. Perioperative outcomes, reoperation rates, recurrence of aortic insufficiency, long-term survival were evaluated.
RESULTS
ARR patients had more concomitant ascending aortic replacement (35% vs 20%, p = 0.002) and shorter cardiopulmonary bypass (189 vs 233 min, p < 0.0001) and aortic cross-clamp (170 vs 204 min, p < 0.0001) times than the VSRR group. Postoperatively, outcomes were similar between groups, including stroke (3% vs 2%) and in-hospital mortality (1.5% vs 2.1%), all p > 0.05. Indications for and rates of reoperation (4% vs 5%, p = 0.62) of the aortic valve and proximal aorta were similar between ARR and VSRR groups with reoperations occurring a mean of 3.2 years after initial root replacement. The ARR group had less moderate-to-severe AI than the VSRR group (1.6% vs 14%, p = 0.002) a mean of 3 years after surgery. Ten-year survival was similar between ARR (84%) and VSRR (82%) (p = 0.69) groups.
CONCLUSIONS
Both ARR and VSRR can be performed with acceptable short- and long-term outcomes in patients with moderate-to-severe AI.