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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
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Valve-Sparing Root Replacement Compared With Composite Valve Graft Procedures in Patients With Aortic Root Dilation
Maral Ouzounian1, Vivek Rao1, Cedric Manlhiot1
1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Department of Surgery, University of Toronto, Toronto, Canada.
Journal of the American College of Cardiology
|October 22, 2016
Summary
Aortic valve-sparing (AVS) surgery offers better long-term outcomes than composite valve grafts (CVG) for aortic root aneurysms. AVS reduces cardiac mortality and valve complications, making it ideal for younger patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Aortic valve-sparing (AVS) operations are alternatives to composite valve graft (CVG) procedures for aortic root aneurysms.
- Comparative long-term outcomes between AVS and CVG are not well-established.
Purpose of the Study:
- To compare the long-term results of AVS procedures with CVG operations in patients with aortic root aneurysms.
- To evaluate the efficacy and safety of AVS versus CVG in a large patient cohort.
Main Methods:
- A total of 616 patients (<70 years, no aortic stenosis) underwent elective aortic root surgery between 1990-2010.
- Procedures included AVS (n=253), CVG with bioprosthesis (bio-CVG, n=180), and CVG with mechanical prosthesis (m-CVG, n=183).
- Propensity score adjustment was used for group comparisons with a mean follow-up of 9.8 years.
Main Results:
- In-hospital mortality and stroke rates were similar across groups.
- AVS procedures were associated with significantly lower long-term major adverse valve-related events compared to bio-CVG and m-CVG.
- AVS also showed reduced cardiac mortality, reoperations (vs. bio-CVG), and anticoagulant-related hemorrhage (vs. m-CVG).
Conclusions:
- Aortic valve-sparing surgery is associated with reduced cardiac mortality and valve-related complications compared to composite valve grafts.
- AVS is the preferred treatment for young patients with aortic root aneurysms and normal or near-normal aortic valve cusps.
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