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Outcome comparison of different approaches to aortic root aneurysm
Affiliations- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Poland
- 3rd Division of Cardiology and Structural Heart Diseases, Upper-Silesian Heart Center, Katowice, Poland
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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.
Keywords
aortic root aneurysm, aortic root replacement, Bio-Bentall, mechanical Bentall, valve-sparing
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About this articleTitle
Outcome comparison of different approaches to aortic root aneurysm
Journal
Kardiologia Polska (Polish Heart Journal)
Issue
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
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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