Key result
Among propensity-matched patients, aortic valve reimplantation was associated with similar 10-year survival compared to the Bentall procedure, but more late severe aortic regurgitation.
Why the study?
To select the optimum procedure for young, relatively asymptomatic patients requiring elective aortic root replacement by comparing outcomes of native aortic valve reimplantation versus the Bentall procedure.
Does aortic valve reimplantation improve outcomes compared to the Bentall procedure in adults undergoing elective aortic root replacement?
Observational (n=643)
No
Does aortic valve reimplantation improve outcomes compared to the Bentall procedure in adults undergoing elective aortic root replacement?
Aortic valve reimplantation offers similar 10-year survival and freedom from reintervention compared to the Bentall procedure, supporting its use as a valve-sparing alternative in appropriate patients despite a higher risk of late aortic regurgitation.
Answers are grounded in this paper and cite their sources.
Reimplantation yields similar survival but more late AR; observational data leave preference over Bentall open for randomized confirmation.
Background A bioprosthesis- or mechanical-prosthesis–containing polyester graft (composite graft) is standard surgical management for aortic root aneurysms (Bentall procedure), but particularly in the young patient in whom a bioprosthesis is likely to deteriorate and a mechanical prosthesis mandates life-long anticoagulation, valve-sparing procedures have been devised. One such procedure involves reimplantation of the native aortic valve in the polyester graft. With focus on selecting the optimum procedure for young relatively asymptomatic patients, we compared outcomes of reimplantation of the aortic valve versus the Bentall procedure and identified factors influencing outcomes. Methods From January 2000 to January 2017, 643 adults age ≤ 70 with tricuspid aortic valves underwent elective aortic root replacement with either reimplantation (n = 448/70%) or a composite valve graft (Bentall) procedure (n = 195/30%). Outcomes were compared in 100 propensity-matched pairs. Results Patients with fewer symptoms, less aortic regurgitation (AR), higher left ventricular ejection fraction, and smaller cross-sectional aortic area/height ratio had a higher likelihood of valve repair with reimplantation (all p < 0.02) versus receiving a Bentall procedure. Operative mortality was 0.16% (reimplantation, 1/448, 0.22%; Bentall 0/195, 0%). After reimplantation, 8-year freedom from severe AR was 95% and 10-year freedom from reintervention was 98%. Ten-year survival was 95%. Higher preoperative AR grade (p < 0.0001) but not larger root diameter (p = 0.3) was associated with higher grade of late regurgitation after a reimplantation procedure. Among propensity-matched patients, reimplantation compared with a Bentall was associated with similar 10-year survival (89% vs. 94%), but more late AR (8-year freedom from severe AR: 93% vs. 99.9%) and greater early reduction in, but similar late, left ventricular mass (104 vs. 105 g•m–2 at 8 years). Conclusion Excellent aortic valve reimplantation results versus Bentall lead us to recommend reimplantation more often in patients who present with even moderately severe or severe AR and significantly enlarged aortic roots.
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Svensson et al. (2022) conducted an observational in Aortic root aneurysms (n=643). Aortic valve reimplantation vs. Bentall procedure (composite valve graft) was evaluated on 10-year survival (propensity-matched) (p=0.8). Among propensity-matched patients, aortic valve reimplantation was associated with similar 10-year survival compared to the Bentall procedure, but more late severe aortic regurgitation.
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