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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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Matched comparison between external aortic root support and valve-sparing root replacement.
Lucas Van Hoof1, Marie Lamberigts1, Dries Noé1
1Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium.
Heart (British Cardiac Society)
|January 17, 2023
Summary
Personalised external aortic root support (PEARS) and valve-sparing root replacement (VSRR) show similar survival and reintervention rates for aortic root aneurysms. Both surgical techniques offer favorable mid-term outcomes for patients with connective tissue disease.
Area of Science:
- Cardiovascular Surgery
- Aortic Surgery
- Aortic Aneurysm Repair
Background:
- Aortic root aneurysms in patients with connective tissue disease pose significant surgical challenges.
- Valve-sparing root replacement (VSRR) and personalised external aortic root support (PEARS) are surgical options, but direct comparisons are complex due to differing indications and techniques.
Purpose of the Study:
- To compare the outcomes of PEARS and VSRR in patients with syndromic aortic root aneurysms using propensity score matching.
- To evaluate survival, freedom from reintervention, and preservation of aortic regurgitation status between the two surgical approaches.
Main Methods:
- A propensity score (PS) matched analysis was conducted on patients with connective tissue disease undergoing elective surgery for aortic root aneurysm (<60 mm) with mild aortic regurgitation (<1/4).
- Eighty patients were matched in each cohort (PEARS and VSRR).
- Survival, freedom from reintervention, and freedom from significant aortic regurgitation (≥2/4) were assessed using Kaplan-Meier analysis.
Main Results:
- At a median follow-up of 25 months (PEARS) and 55 months (VSRR), 5-year survival was similar (98% for PEARS vs. 99% for VSRR, p=0.99).
- There were no significant differences in freedom from valve or ascending aortic/arch reintervention between the matched groups.
- Freedom from significant aortic regurgitation (≥2/4) at 5 years was comparable (97% for PEARS vs. 92% for VSRR, p=0.55). PEARS had a higher rate of reintervention for coronary issues (4.4%) with one death (0.6%), while VSRR had 7% reinterventions for bleeding.
Conclusions:
- Both VSRR and PEARS provide favorable mid-term outcomes, including survival, freedom from reintervention, and preservation of valve function.
- The choice between VSRR and PEARS may depend on the specific disease stage of the patient.
- The study's retrospective nature and differing follow-up durations are acknowledged limitations.
