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Meta-Analysis
. 2023 Sep;226(3):371-378.
doi: 10.1016/j.amjsurg.2023.07.004. Epub 2023 Jul 5.

Long-term outcomes of valve-sparing aortic root versus composite aortic valve graft replacement for aortic root aneurysm: Meta-analysis of reconstructed time-to-event data

Michel Pompeu Sá  1 , Xander Jacquemyn  2 , Jef Van den Eynde  2 , Danny Chu  3 , Derek Serna-Gallegos  3 , Joseph S Coselli  4 , Ibrahim Sultan  3
Affiliations
Meta-Analysis

Long-term outcomes of valve-sparing aortic root versus composite aortic valve graft replacement for aortic root aneurysm: Meta-analysis of reconstructed time-to-event data

Michel Pompeu Sá et al. Am J Surg. 2023 Sep.

Abstract

Background: We aimed to evaluate the long-term outcomes of valve-sparing aortic root replacement (VSARR) versus composite aortic valve graft replacement (CAVGR) for aortic root aneurysms.

Methods: Meta-analysis of Kaplan-Meier-derived time-to-event data from studies with follow-up including propensity-score matching or propensity-score adjustment.

Results: Six studies met our eligibility criteria, comprising 3215 patients (1770 patients treated with VSARR and 1445 patients with CAVGR). We observed a statistically significant difference for overall survival favoring VSARR (HR 0.63, 95%CI 0.49-0.82, P ​= ​0.001), but no statistically significant difference in the risk of reoperation (HR 0.77, 95%CI 0.51-1.14, P ​= ​0.187) in the overall follow-up. Landmark analyses revealed that, in the first 10 years after the procedure, reoperation rates were comparable between VSARR and CAVGR (HR 0.96, 95%CI 0.62-1.48, p ​= ​0.861), but the results beyond 10 years showed improved rates of freedom from reoperation in patients undergoing VSARR (HR 0.10, 95%CI 0.01-0.78; p ​= ​0.027).

Conclusion: VSARR seems to confer better long-term survival and lower risk of reoperation in the follow-up of patients treated for aortic root aneurysm when compared with CAVGR.

Keywords: Aortic diseases; Aortic valve; Cardiac surgical procedures; Cardiovascular surgical procedures; Meta-analysis; Thoracic aorta.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ibrahim Sultan receives institutional research support from Abbott, Artivion, Boston Scientific, Edwards, Medtronic, Terumo Aortic. Joseph Coselli. participates in clinical studies with and/or consults for Terumo Aortic, Medtronic, W.L. Gore & Associates, CytoSorbents, and Abbott Laboratories and receives royalties and grant support from Terumo Aortic, The Marfan Foundation, and Stanford University. Danny Chu is proctor and consultant for the Japanese Organization for Medical Device Development, Inc. All other authors have reported that they have no relationships relevant to the contents of this study to disclose.

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