Key result
Valve-sparing root replacement reduces early death ~66% and lowers late mortality versus Bentall in ATAAD.
Why the study?
Conflicting views exist regarding the status of valve-sparing root replacement as a proper treatment for acute type A aortic dissection.
Does valve-sparing root replacement improve mortality compared to the Bentall procedure in patients with acute type A aortic dissection?
Meta-Analysis (n=706)
Does valve-sparing root replacement improve mortality compared to the Bentall procedure in patients with acute type A aortic dissection?
Valve-sparing root replacement in acute type A aortic dissection is associated with lower early and late mortality compared to the Bentall procedure, despite a higher risk of reintervention.
Answers are grounded in this paper and cite their sources.
May favor valve-sparing root replacement over Bentall for lower mortality in acute type A dissection; leaves open durability and RCT confirmation.
OBJECTIVES: There are conflicting views regarding the status of valve-sparing root replacement (VSRR) as a proper treatment for acute type A aortic dissection (AAAD). Our goal was to compare the early and late outcomes of VSRR versus those of the Bentall procedure in patients with AAAD. METHODS: We performed a systematic review and meta-analysis of 9 studies to compare the outcomes of VSRR with those of the Bentall procedure in patients with AAAD. We focused on the following issues: early and late mortality rates, re-exploration, thromboembolization/bleeding events, infective endocarditis and reintervention rates. RESULTS: A total of 706 patients with AAAD who underwent aortic root surgery were analysed; 254 patients were treated with VSRR and 452 with the Bentall procedure. VSRR was associated with a reduced risk of early death [odds ratio (OR) 0.34; 95% confidence interval (CI) 0.21-0.57] and late death (OR 0.34; 95% CI 0.21-0.57) compared with the Bentall procedure. No statistically significant difference was observed between the VSRR and Bentall groups with pooled ORs (OR 0.77; 95% CI 0.47-1.27, OR 0.61; 95% CI 0.32-1.18 and OR 0.71; 95% CI 0.23-2.15) for re-exploration, thromboembolization/bleeding and postoperative infective endocarditis, respectively. An increased risk of reintervention was observed for the VSRR compared to the Bentall group (OR 3.79; 95% CI 1.27-11.30). The pooled rate of reintervention incidence was 1.6% (95% CI 0.0-3.7%) and 0.4% (95% CI 0.0-1.3%) for the VSRR and the Bentall groups, respectively. CONCLUSIONS: VSRR in patients with AAAD can be performed in experienced centres with excellent short- and long-term outcomes compared to those with the Bentall procedure and thus should be recommended especially for active young patients.
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Wu et al. (2019) conducted a meta-analysis in Acute type A aortic dissection (AAAD) (n=706). Valve-sparing root replacement (VSRR) vs. Bentall procedure was evaluated on Early death (OR 0.34, 95% CI 0.21-0.57). Valve-sparing root replacement reduced the risk of early death and late death compared to the Bentall procedure in acute type A aortic dissection.
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