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April 1, 2022AortaOpen Access

Among propensity-matched patients, aortic valve reimplantation was associated with similar 10-year survival (89% vs. 94%, p=0.8) compared to the Bentall procedure, but more late severe aortic regurgitation.

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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?

Population

643 adults age ≤ 70 with tricuspid aortic valves undergoing elective aortic root replacement

Comparison

Aortic valve reimplantation vs Bentall composite valve graft procedure

Design

Propensity-matched observational cohort study

Key result

Among propensity-matched patients, aortic valve reimplantation was associated with similar 10-year survival (89% vs. 94%, p=0.8) compared to the Bentall procedure, but more late severe aortic regurgitation.

Authors

LSLars G. SvenssonBRBrad F. RosinskiNTNicholas J. Tucker

Discussion

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Overview

Reimplantation yields similar survival but more late AR; observational data leave preference over Bentall open for randomized confirmation.

Study Design

Type

Observational (n=643)

Multicenter

No

Structured PICO

Does aortic valve reimplantation improve outcomes compared to the Bentall procedure in adults undergoing elective aortic root replacement?

P
Population
643 adults age ≤ 70 with tricuspid aortic valves undergoing elective aortic root replacement. Exclusions: age >70 or <18 years, aortic valve reoperation, aortic valve stenosis, infective endocarditis, aortic dissection, emergency surgery, or abnormal cusp number (unicuspid, bicuspid, and quadricuspid).
I
Intervention
Aortic valve reimplantation procedure (n=448)
C
Comparator
Bentall procedure (composite valve graft incorporating either a bioprosthesis [75%] or a mechanical prosthesis [25%]) (n=195)
O
Outcome
Postoperative in-hospital mortality and adverse events, longitudinal postoperative aortic valve regurgitation and stenosis and left ventricular reverse remodeling, reoperation on the aortic valve or thoracic aorta, and time-related mortalityhard clinical

Main Result

Absolute Event Rate: 89% vs 94%

p-value: p=0.8

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.

Limitations

  • Single-institution observational study design
  • Lack of a control arm of medically treated patients with enlarged aortas and aortic regurgitation
  • Short follow-up duration for a large proportion of the cohort
  • Single-institution observational study
  • No control arm of medically treated patients with enlarged aortas and aortic regurgitation

Cite This Study

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 (89% vs. 94%, p=0.8) compared to the Bentall procedure, but more late severe aortic regurgitation.

synapsesocial.com/papers/6a1c03cfbc71fb1015a92b6fhttps://doi.org/10.1055/s-0042-1744135
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Mechanical Bentall versus reimplantation for aortic root replacement: A prospective cohort study2026
  2. 2MODIFIED AORTIC VALVE REIMPLANTATION IN PATIENTS WITH ACUTE AORTIC DISSECTION TYPE A2024
  3. 3Repair of aortic root in patients with aneurysm or dissection: comparing the outcomes of valvesparing root replacement with those from the Bentall procedure2013 · 18 citations
  4. 4Comparison of the Bentall procedure versus valve-sparing aortic root replacement2020 · 9 citations
  5. 5Three decades of reimplantation of the aortic valve—the Brussels Experience2023 · 16 citations