Why the study?
Long-term durability of valve-sparing aortic root replacement, particularly in patients with bicuspid aortic valves compared to tricuspid aortic valves, remains debated.
Does valve-sparing aortic root replacement have different short-term and long-term outcomes in adult patients with bicuspid versus tricuspid aortic valves?
Does valve-sparing aortic root replacement have different short-term and long-term outcomes in adult patients with bicuspid versus tricuspid aortic valves?
Valve-sparing aortic root replacement in patients with bicuspid aortic valves is associated with lower all-cause mortality but a significantly higher long-term reintervention risk compared to those with tricuspid aortic valves.
Supports similar short-term VSARR safety in BAV and TAV; leaves open long-term durability concerns and monitoring needs in BAV.
BACKGROUND Aortic root dilation, linked to bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV), risks aneurysm and dissection. Valve-sparing aortic root replacement (VSARR) preserves native valves, avoiding prosthetic valve complications. Long-term VSARR durability, especially in BAV patients, is debated. We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings. AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients. METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients. PubMed, ScienceDirect, and EMBASE were searched from inception to June 2025. Outcomes included mortality, reintervention, and procedural times. Pooled relative risk (RR) and mean differences (MD) with 95%CI were calculated. Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions; evidence certainty via GRADE. RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included. In-hospital mortality (RR = 0.34, 95%CI: 0.10–1.14, P = 0.08) and reoperation (RR = 1.04, 95%CI: 0.64–1.69, P = 0.87) showed no significant differences. All-cause mortality risk was significantly lower in BAV patients (RR = 0.34, 95%CI: 0.13–0.86, P = 0.02). Overall reintervention risk was significantly greater in BAV patients (RR = 2.64, 95%CI: 1.96–3.55, P < 0.00001). Aortic cross-clamp (MD = 3.35 minutes, 95%CI: -5.06 to 11.76, P = 0.43) and cardiopulmonary bypass times (MD = 3.96 minutes, 95%CI: -10.26 to 18.18, P = 0.59) showed no significant differences but substantial heterogeneity. The certainty of evidence was moderate for reintervention, low for mortality risk and in-hospital reoperation, and very low for procedural times. CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients. However, BAV patients face a significantly higher long-term reintervention risk, highlighting the need for tailored strategies and further research.
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Adugna et al. (2025) studied this question.
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