Valve-sparing approaches and valved conduits for aortic root surgery in patients with Marfan syndrome. Meta-analysis of immediate and long-term results

Valve-sparing procedures in aortic root surgery demonstrate favorable short-term and long-term results. At the same time, the feasibility of valve-sparing procedures in patients with Marfan syndrome is questionable. This meta-analysis compares the immediate and long-term results of valve-sparing approaches and valved conduits in aortic root surgery for patients with Marfan syndrome. Data searching was performed in the MEDLINE, Embase, Cochrane and Web of Science databases. The primary endpoints were redo surgery rate and mortality in long-term period. Long-term aortic insufficiency (AI) +3/+4 was also estimated as a primary endpoint. Secondary endpoints included surgery for acute aortic dissection type A, 30-day mortality, thromboembolism, endocarditis and bleeding. Meta-analysis was carried out in accordance with the PRISMA recommendations 2020. In-hospital mortality was similar (OR 3.46; 95% CI 0.92—12.92; I2=0%; p=0.07). In long-term period, thromboembolism (OR 2.77; 95% CI 1.44—5.33; I2=0%; p=0.002), endocarditis (OR 3.19; 95% CI 1.18—8.61; I2=0%; p=0.02), bleeding (OR 3.46; 95% CI 1.76—6.77; I2=0%; p=0.0003) and mortality (OR 3.18; 95% CI 1.8—5.63; I2=12%; p<0.0001) were significantly more common after implantation of valved conduits. In long-term period, aortic insufficiency +3/+4 was more common after reimplantation (OR 0.17; 95% CI 0.05—0.52; I2=5%; p=0.002). In our study, valve-sparing procedures have advantage regarding the incidence of postoperative complications and mortality. However, long-term freedom from severe aortic insufficiency was higher after implantation of valved conduits.