A multicentre, propensity score matched analysis comparing a valve-sparing approach to valve replacement in aortic...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Aortic root aneurysm management often involves surgical repair.
• Valve-sparing root replacement (VSRR) is preferred for younger patients, but comparative data is limited.
• Composite valve-graft aortic root replacement (CVG-ARR) is an alternative surgical approach.

Purpose of the Study:

• To evaluate the outcomes of valve-sparing root replacement (VSRR).
• To compare VSRR outcomes with composite valve-graft aortic root replacement (CVG-ARR).
• To analyze outcomes in patients with aortic root aneurysm and valve insufficiency, excluding stenosis.

Main Methods:

• A multicenter cohort study comparing VSRR (n=2005) and CVG-ARR (n=218).
• Exclusion criteria included aortic dissection, endocarditis, and valvular stenosis.
• Propensity score matching (3:1 ratio) was used for patient comparison.

Main Results:

• Matched VSRR (n=654) and CVG-ARR (n=218) groups showed 5-year survival of 95.4% vs. 85.4% (P=0.002).
• Freedom from reintervention at 5 years was similar: 96.8% for VSRR vs. 95.4% for CVG-ARR (P=0.98).
• CVG-ARR had significantly more thromboembolic, endocarditis, and bleeding events (P=0.02).

Conclusions:

• VSRR demonstrates excellent outcomes for ascending aortic aneurysms with or without valve insufficiency.
• VSRR offers superior survival and fewer valve-related events compared to CVG-ARR.
• VSRR should be considered for aortic root repair when feasible, even in complex cases at experienced centers.