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Updated: Sep 19, 2025

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Comparative outcomes of aortic root preservation versus root replacement for acute type A aortic dissection:
Dimitrios E Magouliotis1, Serge Sicouri1, Massimo Baudo2
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA.
Objective:
We reviewed the available literature on patients undergoing aortic repair for acute type A aortic dissection (ATAAD) with either aortic root preservation (RP) or root replacement (RR).
Methods:
Original research studies that evaluated the long-term outcomes of the RP versus RR group were identified from 2000 to 2025. Median overall survival (OS) was the primary endpoint. Reoperation-free OS was the secondary endpoint. Sensitivity analyses were performed including risk-adjusted populations, subgroups, and using the leave-one-out method.
Results:
Seventeen studies were included in the qualitative and quantitative synthesis, incorporating data from 7569 patients with a follow-up period of up to 25 years. According to our analysis, RP (4266 patients) demonstrated higher OS compared to RR (2589 patients) groups (HR: 0.83; 95% CI:0.76, 0.91; p < 0.01). The median OS was 13.57 years for the RP group and 13.48 years for the RR group. Nonetheless, the reoperation-free OS was higher in the RR group (HR: 1.39; 95% CI: 1.16, 1.67; p < 0.01). Valve-sparing RR (VSRR) demonstrated the highest long-term OS (p < 0.05).
Conclusion:
RP is associated with superior OS but a higher risk of reoperation, while RR offers greater durability with fewer reoperations, and VSRR may provide the optimal balance of longevity and native valve preservation, warranting further prospective studies.
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