Comparison of Outcomes between Valve-Sparing Root Replacement and the Bentall Procedure in Acute Stanford Type A...

Comparative evidence for valve-sparing root replacement (VSRR) versus the Bentall procedure in acute Stanford type A aortic dissection (ATAAD) remains limited. We compared early and long-term outcomes between these procedures.

We retrospectively analyzed patients with ATAAD who underwent emergency aortic root intervention at Asan Medical Center (1994-2022), comparing VSRR with the Bentall procedure. Stabilized inverse probability of treatment weighting (IPTW) was applied using 6 prespecified clinically relevant covariates. Cox models analyzed all-cause mortality and the composite outcome, and Fine-Gray competing risk models analyzed stroke, infective endocarditis (IE), hemorrhagic events, and reoperation.

Among 82 patients undergoing aortic root intervention (VSRR, n=17; Bentall procedure, n=65), covariate balance improved after IPTW, with standardized mean differences <0.20 for prespecified covariates. Early outcomes showed no clear between-group differences. During a median follow-up of 6.02 years (interquartile range, 1.22-15.42 years), no significant between-group differences were found in all-cause mortality (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.29-2.33; p=0.718) or the composite outcome (HR, 0.70; 95% CI, 0.32-1.53; p=0.368). Competing risk analyses showed no clear differences in stroke (subdistribution HR [sHR], 0.90; 95% CI, 0.15-5.37; p=0.908), IE (sHR, 0.30; 95% CI, 0.004-21.34; p=0.582), hemorrhagic events (sHR, 0.68; 95% CI, 0.07-6.61; p=0.743), or reoperation (sHR, 0.13; 95% CI, 0.004-4.80; p=0.269).

In this single-center ATAAD cohort requiring aortic root intervention, VSRR and the Bentall procedure showed no clear differences in adjusted outcomes. Longer follow-up and larger multicenter studies exploring anatomic and operative variables are warranted.