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Review
. 2019 Jul 1;29(1):74-82.
doi: 10.1093/icvts/ivy364.

Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients

Michel Pompeu Barros Oliveira Sá  1   2   3 , Martinha Milliany Barros Carvalho  2   3 , Dário Celestino Sobral Filho  2   3 , Luiz Rafael Pereira Cavalcanti  1   2 , Roberto Gouvea Silva Diniz  1   2 , Sérgio Costa Rayol  1   2 , Alexandre Magno Macário Nunes Soares  1   2 , Frederico Browne Correia de Araujoe Sá  1   2 , Alexandre Motta Menezes  1   2 , Marie-Annick Clavel  4 , Philippe Pibarot  4 , Ricardo Carvalho Lima  1   2   3
Affiliations
Free article
Review

Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients

Michel Pompeu Barros Oliveira Sá et al. Interact Cardiovasc Thorac Surg. .
Free article

Abstract

Objectives: This study sought to evaluate the impact of surgical aortic root enlargement (ARE) on the perioperative outcomes of aortic valve replacement (AVR).

Methods: Databases were searched for studies published until April 2018 to carry out a systematic review followed by meta-analysis of results.

Results: The search yielded 1468 studies for inclusion. Of these, 10 articles were analysed and their data extracted. A total of 13 174 patients (AVR with ARE: 2819 patients; AVR without ARE: 10 355 patients) were included from studies published from 2002 to 2018. The total rate of ARE was 21.4%, varying in the studies from 5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)] for perioperative mortality showed a statistically significant difference between the groups (among 10 studies), with a higher risk in the 'AVR with ARE' group (OR 1.506, 95% CI 1.209-1.875; P < 0.001), but not when adjusted for isolated AVR + ARE without any concomitant procedures such as mitral valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95% CI 0.968-2.726; P = 0.066-among 6 studies). The 'AVR with ARE' group showed an overall lower risk of significant patient-prosthesis mismatch among 9 studies (OR 0.472, 95% CI 0.295-0.756; P = 0.002) and a higher overall difference in means of indexed effective orifice area among 10 studies (random-effect model: 0.06 cm2/m2, 95% CI 0.029-0.103; P < 0.001).

Conclusions: Surgical ARE seems to be associated with increased perioperative mortality but with lower risk of patient-prosthesis mismatch.

Keywords: Aortic stenosis; Aortic valve replacement; Heart valve prosthesis; Meta-analysis; Prosthesis–patient mismatch.

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