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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Valve-Sparing Root Replacement Versus Bio-Bentall: Inverse Propensity Weighting of 796 Patients
Casidhe-Nicole Bethancourt1, David Blitzer2, Tsuyoshi Yamabe3
1Columbia University Vagelos College of Physicians and Surgeons, New York, New York; Division of Cardiothoracic and Vascular Surgery, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York.
Insights
Valve-sparing root replacement (VSRR) and bioprosthetic Bentall (bio-Bentall) demonstrate comparable 10-year survival and aortic valve reintervention rates. Durable solutions for young patients with bicuspid aortic valves undergoing these procedures remain a challenge.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Aortic root aneurysm necessitates surgical intervention, with valve-sparing root replacement (VSRR) and bioprosthetic Bentall (bio-Bentall) being common approaches.
- Comparing long-term outcomes of VSRR versus bio-Bentall is crucial for surgical decision-making in aortic root pathology.
Purpose of the Study:
- To compare the 10-year survival and freedom from aortic valve reintervention between VSRR and bio-Bentall procedures.
- To identify factors associated with aortic valve reintervention after aortic root surgery.
Main Methods:
- A retrospective review of 796 patients undergoing elective VSRR or bio-Bentall for aortic root aneurysm.
- Inverse probability of treatment weighting (IPTW) was used to balance clinical variables between the VSRR and bio-Bentall groups.
- A Fine and Gray competing risk regression model analyzed factors associated with aortic valve reintervention.
Main Results:
- After IPTW, 10-year survival was similar between VSRR (87.0%) and bio-Bentall (92.7%, P=0.780).
- Cumulative incidence of aortic valve reintervention at 10 years was comparable: 5.9% for VSRR and 10.6% for bio-Bentall (P=0.798).
- Age, body surface area, and bicuspid aortic valve were independently associated with aortic valve reintervention.
Conclusions:
- Both VSRR and bio-Bentall offer excellent and similar 10-year survival and freedom from aortic valve reintervention.
- A significant challenge persists in finding durable valve solutions for younger patients, particularly those with bicuspid aortic valves.
Background:
This large cohort, single-center study compared the 10-year survival and freedom from aortic valve reintervention between valve-sparing root replacement (VSRR) and bioprosthetic Bentall (bio-Bentall).
Methods:
All patients undergoing elective VSRR or bio-Bentall for aortic root aneurysm between March 2005 through October 2019 were retrospectively reviewed (N = 796; n = 360 for VSRR). Inverse probability of treatment weighting (IPTW) balanced clinical variables between groups. Mean follow-up was 58.0 ± 45.4 months (range, 0-167 months).
Results:
After IPTW adjustment, 10-year survival did not differ between VSRR (87.0%) and bio-Bentall (92.7%, P = 0.780). Cumulative incidence of aortic valve reintervention was 5.9% for VSRR (95% confidence interval [CI], 2.9%-10.4%) and 10.6% for bio-Bentall (95% CI, 6.2%-16.4%; P = .798). A Fine and Gray competing risk regression model identified age at operation (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99; P = .015), body surface area (sHR, 6.21; 95% CI, 1.97-19.59; P = .002), and bicuspid aortic valve (sHR, 2.15; 95% CI, 1.04-4.44; P = .038) as independently associated with aortic valve reintervention. For patients aged 50 years or younger, the cumulative incidence of aortic valve reintervention was 16.2% for VSRR (95% CI, 7.0%-28.8%) and 17.8% for bio-Bentall (95% CI, 6.9%-32.8%; P = .363).
Conclusions:
VSRR and bio-Bentall show similar excellent survival and freedom from aortic reintervention rates up to 10 years; however, a durable valve solution for young patients with bicuspid aortic valve remains a challenge.
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