Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Annals of Cardiothoracic Surgery, vol. 12, pp. 149–158

Abstract

Background: Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. Methods: We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. Results: Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. Conclusions: This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs.

Authors 10

1. Stefano Mastrobuoni corresponding

   Cliniques Universitaires Saint-Luc · UCLouvain

   Affiliation as printed

   Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium

2. Pascal J. Govers Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

3. Kevin M. Veen

   Erasmus MC

   Affiliation as printed

   Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

4. Jama Jahanyar

   University of Hawaiʻi at Mānoa · University of Hawaii System

   Affiliation as printed

   Division of Cardiovascular and Thoracic Surgery, Queen's Heart Institute, Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

   Division of Cardiovascular and Thoracic Surgery, Queen’s Heart Institute, Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

5. Silke van Saane Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

6. Antonio Segreto

   Cliniques Universitaires Saint-Luc · UCLouvain

   Affiliation as printed

   Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium

7. Luca Zanella

   Cliniques Universitaires Saint-Luc · University of Padua · UCLouvain

   Affiliation as printed

   Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy

   Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium

8. Laurent de Kerchove

   Cliniques Universitaires Saint-Luc · UCLouvain

   Affiliation as printed

   Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium

9. Johanna J.M. Takkenberg

   Erasmus MC

   Affiliation as printed

   Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

10. Bardia Arabkhani Aachen Department of Cardiothoracic Surgery

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands