Aortic root replacement: comparison of clinical outcome between different surgical techniques

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Ascending aorta aneurysm (AAA) with or without aortic valve regurgitation (AR) necessitates aortic root replacement.
• Surgical technique significantly impacts patient outcomes in these complex cases.

Purpose of the Study:

• To compare the clinical outcomes of different surgical procedures for aortic root replacement in patients with ascending aorta aneurysm.
• To evaluate the influence of valve-sparing root replacement (VSRR) versus the Bentall procedure (with biological or mechanical conduits) on patient survival and complications.

Main Methods:

• Retrospective analysis of 370 patients undergoing aortic root replacement between 2000 and 2011.
• Patients were categorized into three groups: VSRR (n=178), Bentall with biological conduit (n=91), and Bentall with mechanical conduit (n=101).
• Clinical assessment and echocardiography were performed during a mean follow-up of 4.3 years.

Main Results:

• Five-year survival rates were significantly higher for VSRR (95.2%) compared to Bentall procedures (80.9% biological, 79.3% mechanical) (P < 0.01).
• Elective VSRR showed improved survival (96.1%) versus elective Bentall procedures (88.9% biological, 82.3% mechanical) (P = 0.02).
• Freedom from major bleeding events was higher in the VSRR and biological conduit groups (99.3%, 100%) compared to the mechanical conduit group (93.0%) (P = 0.03).

Conclusions:

• Valve-sparing root replacement (VSRR) is a favorable strategy for aortic root replacement.
• In cases requiring the Bentall procedure, biological valved conduits are recommended over mechanical conduits to mitigate late bleeding complications.