A multicentre, propensity score matched analysis comparing a valve-sparing approach to valve replacement in aortic root aneurysm: Insight from the AVIATOR database
European Journal of Cardio-Thoracic Surgery, vol. 63
Abstract
OBJECTIVES: Our goal was to evaluate the outcome of valve-sparing root replacement (VSRR) and to compare the outcomes to those of patients having composite valve-graft conduit aortic root replacement (CVG-ARR) in a cohort of patients with aortic root aneurysm ± valve insufficiency, without valvular stenosis. Although valve-sparing procedures are preferable in young patients, there is a lack of comparative data in comparable patients. METHODS: The VSRR procedures were performed in 2005 patients, and 218 patients underwent a CVG-ARR procedure. Exclusion criteria included aortic dissection, endocarditis and valvular stenosis. Propensity score matching (3:1 ratio) was applied to compare VSRR (reimplantation 33% and remodelling 67%) and CVG-ARR. RESULTS: We matched 218 patients with CVG-ARR to 654 patients with VSRR (median age, 56.0; median follow-up was 4 years in both groups; interquartile range 1-5 years). Early mortality was 1.1% of those who had VSRR versus 2.3% in those who had CVG-ARR. Survival was 95.4% [95% confidence interval (CI) 94-97%] at 5 years in patients who had VSRR versus 85.4% (95% CI 82-92%) in those who had CVG-ARR; P = 0.002. Freedom from reintervention at 5 years was 96.8% (95% CI 95-98%) with VSRR and 95.4% (95% CI 91-99%) with CVG-ARR (P = 0.98). Additionally, there were more thromboembolic, endocarditis and bleeding events in the patients who had CVG-ARR (P = 0.02). CONCLUSIONS: This multicentre study shows excellent results after valve-sparing root replacement in patients with an ascending aortic aneurysm with or without valve insufficiency. Compared to composite valve-graft aortic root replacement, survival is better and valve-related events are fewer. Consequently, valve-sparing procedures should be considered whenever a durable repair is feasible. We advocate a valve-sparing strategy even in more complex cases when performed in experienced centres.
Authors 17
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Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center (LUMC) , Leiden, The Netherlands
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Robert J.M. Klautz Aachen
Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center (LUMC) , Leiden, The Netherlands
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Affiliation as printed
AVIATOR registry, Heart Valve Society , The Netherlands
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Cliniques Universitaires Saint-Luc
Affiliation as printed
Cliniques universitaires Saint-Luc , Bruxelles, Belgium
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Cliniques Universitaires Saint-Luc
Affiliation as printed
Cliniques universitaires Saint-Luc , Bruxelles, Belgium
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Institute Mutualiste Montsouris
Affiliation as printed
Institut Mutualiste Montsouris , Paris, France
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Affiliation as printed
Homburg-Saarland University Medical Center , Homburg, Germany
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Affiliation as printed
Montréal Heart Institute , Montréal, Quebec, Canada
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Affiliation as printed
Montréal Heart Institute , Montréal, Quebec, Canada
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Affiliation as printed
Hospital de Cruces , Bilbao, Spain
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Universitair Ziekenhuis Leuven
Affiliation as printed
University Hospitals Leuven , Leuven, Belgium
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Universitair Ziekenhuis Leuven
Affiliation as printed
University Hospitals Leuven , Leuven, Belgium
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Amsterdam University Medical Centers
Affiliation as printed
Amsterdam UMC , Amsterdam, Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Amsterdam UMC , Amsterdam, Netherlands
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Affiliation as printed
University Hospital Dubrava , Zagreb, Croatia
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Affiliation as printed
Regional Hospital “Ca Foncello” , Treviso, Italy
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Thomas J. van Brakel Aachen
Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center (LUMC) , Leiden, The Netherlands
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