open access

Vol 80, No 4 (2022)
Original article
Published online: 2022-02-13
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Outcome comparison of different approaches to aortic root aneurysm

Radosław Gocoł1, Jarosław Bis12, Marcin Malinowski12, Łukasz Morkisz1, Mikołaj Jodłowski2, Tomasz Darocha3, Joanna Ciosek4, Wojciech Wojakowski4, Marek A Deja12
DOI: 10.33963/KP.a2022.0045
·
Pubmed: 35152397
·
Kardiol Pol 2022;80(4):436-444.
Affiliations
  1. Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
  2. Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
  3. Department of Anesthesiology and Intensive Care, Medical University of Silesia, Poland
  4. 3rd Division of Cardiology and Structural Heart Diseases, Upper-Silesian Heart Center, Katowice, Poland

open access

Vol 80, No 4 (2022)
Original article
Published online: 2022-02-13

Abstract

Background: The treatment of aortic root aneurysm remains challenging for both cardiac surgeons and cardiologists.
Aims: This study aimed to assess and compare the long-term outcomes of different approaches to aortic root replacement (ARR).
Methods: All elective patients operated for aortic root aneurysm with or without aortic regurgitation at our institution over a 10-year period were included. We excluded patients with any degree of aortic stenosis and with active endocarditis. We assessed mortality, freedom from reoperation, freedom from aortic valve regurgitation, and the rate of hemorrhagic and thromboembolic complications.
Results: Two hundred and four patients underwent elective aortic root replacement: 107 (53%) valve-sparing aortic root replacement (VSARR), 35 (17%) mechanical Bentall procedure (MB), and 62 (30%) Bio-Bentall procedure (BB). Early mortality for VSARR, BB, and MB group was 2.8%, 4.8%, and 0%, respectively (P = 0.40). Estimated 5-year survival was: 90.2% vs. 78.4% vs. 94.2%, respectively (P = 0.12), 5-year freedom from reoperation: 97.8%, 96.6%, and 96.8%, respectively (P = 0.99). Estimat-ed 5-year freedom from complications was: 94.2%, 83.1% and 57.3% in the VSARR, BB and MB group, respectively (P <0.001). On last follow-up echocardiography, 90.5%, 98.4%, and 97.1% (P = 0.08) of patients were free from aortic regurgitation grade 2 or higher. The median (IQR) aortic valve peak gradient was 9 (6–12) mm Hg, 12 (10–18) mm Hg and 16 (14–22) mm Hg, respectively (P <0.001). Complications were predicted by mechanical Bentall (hazard ratio, 6.70 [2.54–17.63]; P <0.001).
Conclusion: With the same mortality, freedom from reoperation, and a minimal late complication rate in comparison with mechanical Bentall and Bio-Bentall, VSARR might be the preferred approach to aortic root aneurysm.

Abstract

Background: The treatment of aortic root aneurysm remains challenging for both cardiac surgeons and cardiologists.
Aims: This study aimed to assess and compare the long-term outcomes of different approaches to aortic root replacement (ARR).
Methods: All elective patients operated for aortic root aneurysm with or without aortic regurgitation at our institution over a 10-year period were included. We excluded patients with any degree of aortic stenosis and with active endocarditis. We assessed mortality, freedom from reoperation, freedom from aortic valve regurgitation, and the rate of hemorrhagic and thromboembolic complications.
Results: Two hundred and four patients underwent elective aortic root replacement: 107 (53%) valve-sparing aortic root replacement (VSARR), 35 (17%) mechanical Bentall procedure (MB), and 62 (30%) Bio-Bentall procedure (BB). Early mortality for VSARR, BB, and MB group was 2.8%, 4.8%, and 0%, respectively (P = 0.40). Estimated 5-year survival was: 90.2% vs. 78.4% vs. 94.2%, respectively (P = 0.12), 5-year freedom from reoperation: 97.8%, 96.6%, and 96.8%, respectively (P = 0.99). Estimat-ed 5-year freedom from complications was: 94.2%, 83.1% and 57.3% in the VSARR, BB and MB group, respectively (P <0.001). On last follow-up echocardiography, 90.5%, 98.4%, and 97.1% (P = 0.08) of patients were free from aortic regurgitation grade 2 or higher. The median (IQR) aortic valve peak gradient was 9 (6–12) mm Hg, 12 (10–18) mm Hg and 16 (14–22) mm Hg, respectively (P <0.001). Complications were predicted by mechanical Bentall (hazard ratio, 6.70 [2.54–17.63]; P <0.001).
Conclusion: With the same mortality, freedom from reoperation, and a minimal late complication rate in comparison with mechanical Bentall and Bio-Bentall, VSARR might be the preferred approach to aortic root aneurysm.

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Keywords

aortic root aneurysm, aortic root replacement, Bio-Bentall, mechanical Bentall, valve-sparing

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About this article
Title

Outcome comparison of different approaches to aortic root aneurysm

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 80, No 4 (2022)

Article type

Original article

Pages

436-444

Published online

2022-02-13

Page views

276

Article views/downloads

120

DOI

10.33963/KP.a2022.0045

Pubmed

35152397

Bibliographic record

Kardiol Pol 2022;80(4):436-444.

Keywords

aortic root aneurysm
aortic root replacement
Bio-Bentall
mechanical Bentall
valve-sparing

Authors

Radosław Gocoł
Jarosław Bis
Marcin Malinowski
Łukasz Morkisz
Mikołaj Jodłowski
Tomasz Darocha
Joanna Ciosek
Wojciech Wojakowski
Marek A Deja

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