Researchers wanted to determine the state of the art in the surgical treatment of aortic root diseases in a high-volume center. Aortic root replacement was performed on 890 patients between May 1997 and January 2014, with 289 receiving a mechanical composite valved graft, 421 receiving a biologic composite valved graft, and 180 receiving a valve-sparing reconstruction. The disparities in baseline characteristics between patients assigned to the different procedures were neutralized using propensity matching analysis. Operative mortality was 0.2% (0% in the valve-sparing reconstruction group), and significant postoperative problems occurred in less than 0.5% of the patients. Age, non-elective surgery, renal status, reoperation, New York Heart Association class, ejection fraction, and concurrent operations were predictors of poor in-hospital outcomes. The five-year survival rate was 89.4%. Previous myocardial infarction, preoperative renal condition, redo surgery, and simultaneous operations were all linked to a higher risk of death after surgery. The type of procedure done did not affect in-hospital or late outcomes in the propensity-matched groups. At 5 years, the mechanical composite valved graft group had a 0% reintervention rate. The biologic mixed valved graft group had a 2.4% reintervention rate. The valve-sparing reconstruction series had a 7.3% reintervention rate.
Researchers can now perform Aortic root replacement in high-volume aortic facilities with reduced perioperative risk. Early or late survival is unaffected by the type of operation performed. Although the mechanical composite valved graft is still the gold standard in durability, biologic composite valved grafts and valve-sparing reconstruction are great alternatives for those who cannot or do not want to take long-term anticoagulation.
Reference:www.jtcvs.org/article/S0022-5223(15)01225-8/fulltext
