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Meta-Analysis
. 2023 Jul 3;18(1):206.
doi: 10.1186/s13019-023-02329-8.

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis

Yiding Zuo  1 , Ruixi Tan  1 , Chaoyi Qin  2
Affiliations
Meta-Analysis

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis

Yiding Zuo et al. J Cardiothorac Surg. .

Abstract

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), I2 = 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), I2 = 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), I2 = 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.

Keywords: Bicuspid aortic valve; Reimplantation; Remodeling; Tricuspid aortic valve; Valve-sparing aortic root replacement.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Selection algorithm
Fig. 2
Fig. 2
NOS quality evaluation form
Fig. 3
Fig. 3
Forest plots of in-hospital mortality events of patients in BAV and TAV cohort
Fig. 4
Fig. 4
Forest plots of in-hospital reoperation events of patients in BAV and TAV cohort
Fig. 5
Fig. 5
Forest plots of overall mortality events of patients in BAV and TAV cohort
Fig. 6
Fig. 6
Forest plots of overall reintervention events of patients in BAV and TAV cohort
Fig. 7
Fig. 7
Forest plots of reintervention events of patients in BAV and TAV cohort in different follow-up periods. a Forest plots of short-term reintervention events of patients in BAV and TAV cohort. b Forest plots of mid-term reintervention events of patients in BAV and TAV cohort. c Forest plots of long-term reintervention events of patients in BAV and TAV cohort
Fig. 8
Fig. 8
Forest plots of reintervention events of patients in BAV and TAV cohort in different follow-up periods. a Forest plots of reintervention events between 3 and 5 years follow-up of patients in BAV and TAV cohort. b Forest plots of reintervention events over 5 years of patients in BAV and TAV cohort
Fig. 9
Fig. 9
Forest plots of secondary endpoints of patients in BAV and TAV cohort in different follow-up periods. a Forest plots of aortic cross-clamping time of patients in BAV and TAV cohort. b Forest plots of total CPB time of patients in BAV and TAV cohort
Fig. 10
Fig. 10
The funnel plot for included studies. The funnel plot was symmetrical which meant no significant publication bias. Compared long-term reintervention events of patients in BAV and TAV cohort
Fig. 11
Fig. 11
Summary of study characteristics
Fig. 12
Fig. 12
Summary of study characteristics
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