Key result
Aortic root enlargement during SAVR is associated with similar mortality and survival versus SAVR alone.
Why the study?
Aortic root enlargement lowers patient prosthesis mismatch risk after SAVR in small annuli, but whether it increases operative mortality remains controversial.
Does aortic root enlargement during isolated surgical aortic valve replacement increase operative mortality or complications in patients undergoing SAVR?
Cohort (n=868)
Does aortic root enlargement during isolated surgical aortic valve replacement increase operative mortality or complications in patients undergoing SAVR?
Aortic root enlargement during surgical aortic valve replacement can be safely performed without increasing early mortality or complications, yielding excellent intermediate-term survival.
Aortic root enlargement may be performed safely during SAVR; leaves open need for randomized confirmation.
OBJECTIVES: Aortic root enlargement (ARE) lowers the risk of patient prosthesis mismatch after surgical aortic valve replacement (SAVR) in patients with small annular size. Whether ARE is associated with increased operative mortality is controversial. This study compares the early and intermediate outcomes in patients undergoing SAVR with and without ARE. METHODS: All patients undergoing isolated SAVR with and without ARE from 2015 to 2020 were analyzed. Propensity-matching was used to adjust for possible confounding variables. Kaplan-Meier analysis and log-rank test were used to estimate and compare overall outcomes and survival in the study cohorts. RESULTS: Among 868 isolated SAVRs, ARE was performed in 54 (6.2%) patients. Before matching, mean age was similar but female sex (67.4% vs. 29.6%; SD: -0.82) and previous AVR (18.9% vs. 3.9%; SD: -0.48) were more common in patients undergoing SAVR + ARE versus SAVR alone. A bovine pericardial patch was used for 81.5% (44 of 54) of ARE, with a Dacron patch in the rest. After propensity matching, the average cardiopulmonary bypass (138.2 ± 34.9 vs. 102.9 ± 33.0 min; p < 0.01) and cross-clamp times (113.8 ± 26.7 vs. 83.0 ± 28.4 min; p < 0.01) were longer in the SAVR + ARE group. There were no significant differences in postoperative stroke, new-onset dialysis, pacemaker placement, reoperation for bleeding, length of hospital stay, or 30-day readmission. Thirty-day mortality (0% vs. 0.6%, p = 1.0) and 5-year survival (96.3% vs. 95.7%, p = 0.86) were also similar. CONCLUSIONS: ARE during surgical AVR can be safely performed without an increase in complications with excellent early and intermediate-term survival.
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Shih et al. (2022) conducted a cohort in Isolated surgical aortic valve replacement (n=868). Aortic root enlargement (ARE) during SAVR vs. SAVR alone was evaluated on 30-day mortality (p=1.0). Aortic root enlargement during surgical aortic valve replacement had similar 30-day mortality (0% vs 0.6%, p=1.0) and 5-year survival (96.3% vs 95.7%, p=0.86) compared to SAVR alone.
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