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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Analysing the Extent of Surgery on Short- and Long-Term Outcomes after Planned Major Aortic Surgery

Marcus Taylor1,2, David Rose1, Palanikumar Saravanan3

  • 1Department of Cardiothoracic Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool FY3 8NR, United Kingdom.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|December 18, 2025
PubMed

Insights

Extensive aortic surgery, including aortic root or arch replacement, is safe for selected patients. While combined extensions slightly increase in-hospital mortality, there is no long-term survival impact from more extensive thoracic aortic repair.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Surgery
  • Aortic Aneurysm Repair

Background:

  • Planned proximal thoracic aortic replacement is a standard cardiac surgical procedure.
  • The impact of extending aortic replacement to the aortic root or arch on short-term risk and long-term benefit is not well-defined.

Purpose of the Study:

  • To evaluate the short-term and long-term outcomes of patients undergoing planned proximal thoracic aortic replacement.
  • To determine if extending the repair to the aortic root and/or aortic arch affects mortality, survival, stroke, transfusion rates, and length of stay.

Main Methods:

  • Retrospective review of 491 patients undergoing first-time, non-emergency proximal thoracic aortic replacement.
  • Patients were categorized into four groups: isolated ascending aorta, proximal extension, distal extension, and combined extension.
  • Outcomes analyzed included in-hospital mortality, overall survival, stroke, blood transfusion, and post-operative length of stay.

Main Results:

  • Overall in-hospital mortality was 2.6%.
  • Combined aortic root and arch replacement was independently associated with increased in-hospital mortality (OR 8.220).
  • No independent association was found between the extent of aortic intervention and long-term survival.

Conclusions:

  • Planned major aortic surgery demonstrates low mortality and morbidity in the current era.
  • More extensive aortic interventions, including aortic root and arch replacement, can be safely performed in appropriately selected patients.
  • Extended aortic repair does not appear to negatively impact overall long-term survival.
Abstract

Keywords:
aortic archaortic rootoverall survivalrisk modelthoracic aorta

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