Key result
Aortic valve sparing shows identical 30-day mortality versus aortic root replacement for aortic root aneurysms.
Why the study?
Aortic root replacement (Bentall operation) and aortic valve sparing (David operation) are alternative surgical techniques for treating aortic root aneurysm, prompting a comparison of 30-day mortality, postoperative care, and complications.
Does aortic valve sparing (David operation) compared to aortic root replacement (Bentall operation) improve 30-day mortality and complications in patients with aortic root aneurysm?
Observational (n=45)
Does aortic valve sparing (David operation) compared to aortic root replacement (Bentall operation) improve 30-day mortality and complications in patients with aortic root aneurysm?
Both Bentall and David operations are valid alternatives for aortic root aneurysm with comparable 30-day mortality, though the David procedure may be associated with more residual aortic regurgitation during the learning curve.
Answers are grounded in this paper and cite their sources.
Comparable short-term mortality supports either procedure in selected patients; leaves open long-term durability and complication comparisons.
Background Aortic root replacement (Bentall operation) or Aortic valve sparing (David operation) are alternative surgical techniques for the treatment of aortic root aneurysm. The aim of the current study was to compare our 30-days mortality, post-operative care and complications associated with both procedures. Methods From January 2015 to December 2017, 45 consecutive patients (40 men; 88.9%), with mean age 43.2 ± 6.55 years underwent either Bentall operation (Group A: 30 patients; 66.7%) or David operation (Group B: 15 patients; 33.3%); according to surgeons' preference or expertise. Group A patients were significantly older (47.1 ± 7.6 vs. 39.3 ± 5.5 years; P = 0.001), more hypertensive (10 patients; 33.3% vs. none; P = 0.019), had higher serum creatinine level (1.3 ± 0.28 vs. 39.3 ± 5.5 vs. 1.07 ± 0.12 mg/dl; P = 0.004), larger LVEDD (6.03 ± 0.4 vs. 5.40 ± 0.16 cm; P < 0.001) and lower EF% (56.6 ± 6.31 vs. 61.3 ± 3.51; P = 0.011) but needed shorter aortic cross clamp (101.8 ± 19.9 vs. 200 ± 16.9 min; P = 0.011) and bypass times (151.68 ± 17.2 vs. 266.6 ± 25.8 min; P < 0.001); compared to Group B. Results Overall 30-day mortality was 6.7% in both groups: 2 patients in Group A and 1 patient in Group B. Mortalities were significantly older (54.3 ± 7.23 vs. 43.9 ± 7.6 years; P = 0.025), had larger aortic root (71.6 ± 1.31 vs. 61.2 + 0.78 cm: P = 0.037) and left ventricular end diastolic diameters (6.37 ± 0.68 vs. 5.79 ± 0.44 cm; P < 0.038), needed prolonged mechanical ventilation (51.67 ± 24.39 vs. 92.33 ± 19.66 h; P = 0.007) and ICU stay (5.07 ± 1.98 vs. 8.33 ± 1.53 days; P = 0.008); compared to survivors. Group B patients had significantly longer aortic cross clamp and bypass times but showed Although 4 group B patients showed severe residual aortic regurge, compared to none in Group A (P = 0.23), yet. Other hospital complications were equally comparable. Conclusion Factors affecting our 30-days mortality were related to the severity of the disease. Both procedures could be valid alternatives, yet more cases of residual aortic regurge are expected with David operation, especially in the early learning curve.
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Rizk et al. (2018) conducted an observational in Aortic root aneurysm (n=45). Aortic root replacement (Bentall operation) vs. Aortic valve sparing (David operation) was evaluated on 30-day mortality. Aortic root replacement (Bentall operation) and aortic valve sparing (David operation) for aortic root aneurysm resulted in identical 30-day mortality rates.
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