Key result
Valve-sparing aortic root replacement in patients with bicuspid aortic valves resulted in similar in-hospital mortality compared to tricuspid aortic valves (0.00% vs 1.93%, RR 0.33), but was associated with lower long-term mortality and higher reintervention rates.
Why the study?
Valve-sparing aortic root replacement is safe and effective for aortic root aneurysm, but how outcomes differ between patients with bicuspid versus tricuspid aortic valves needed investigation.
Does valve-sparing aortic root replacement yield different clinical outcomes in patients with bicuspid aortic valve compared to those with tricuspid aortic valve?
Meta-Analysis (n=3,263)
Does valve-sparing aortic root replacement yield different clinical outcomes in patients with bicuspid aortic valve compared to those with tricuspid aortic valve?
Relative Risk: 0.33 (95% CI 0.09–1.26)
Absolute Event Rate: 0% vs 1.93%
p-value: p=0.11
Valve-sparing aortic root replacement is a safe and effective approach for aortic root dilation in both bicuspid and tricuspid aortic valve patients, with BAV patients showing better long-term survival but potentially higher long-term reintervention risk.
Supports valve-sparing root replacement in BAV patients; extends meta-analytic evidence of superior long-term survival versus TAV.
Background Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). Design Meta-analysis with meta-regression and systematic review. Setting Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. Interventions All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. Result Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I 2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I 2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I 2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. Conclusion The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.
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Zuo et al. (2023) conducted a meta-analysis in Aortic root aneurysm/dilation (n=3,263). Bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV) was evaluated on In-hospital mortality (RR 0.33, 95% CI 0.09, 1.26, p=0.11). Valve-sparing aortic root replacement in patients with bicuspid aortic valves resulted in similar in-hospital mortality compared to tricuspid aortic valves (0.00% vs 1.93%, RR 0.33), but was associated with lower long-term mortality and higher reintervention rates.
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