Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients.

Autor:	Sá MPBO; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil.; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil., Carvalho MMB; University of Pernambuco - UPE, Recife, Brazil.; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil., Sobral Filho DC; University of Pernambuco - UPE, Recife, Brazil.; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil., Cavalcanti LRP; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil., Diniz RGS; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil., Rayol SC; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil., Soares AMMN; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil., Sá FBCA; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil., Menezes AM; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil., Clavel MA; Institut Universitaire de Cardiologie e de Pneumologie du Québec, Quebec City, QC, Canada., Pibarot P; Institut Universitaire de Cardiologie e de Pneumologie du Québec, Quebec City, QC, Canada., Lima RC; Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.; University of Pernambuco - UPE, Recife, Brazil.; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2019 Jul 01; Vol. 29 (1), pp. 74-82.
DOI:	10.1093/icvts/ivy364
Abstrakt:	Objectives: This study sought to evaluate the impact of surgical aortic root enlargement (ARE) on the perioperative outcomes of aortic valve replacement (AVR). Methods: Databases were searched for studies published until April 2018 to carry out a systematic review followed by meta-analysis of results. Results: The search yielded 1468 studies for inclusion. Of these, 10 articles were analysed and their data extracted. A total of 13 174 patients (AVR with ARE: 2819 patients; AVR without ARE: 10 355 patients) were included from studies published from 2002 to 2018. The total rate of ARE was 21.4%, varying in the studies from 5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)] for perioperative mortality showed a statistically significant difference between the groups (among 10 studies), with a higher risk in the 'AVR with ARE' group (OR 1.506, 95% CI 1.209-1.875; P < 0.001), but not when adjusted for isolated AVR + ARE without any concomitant procedures such as mitral valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95% CI 0.968-2.726; P = 0.066-among 6 studies). The 'AVR with ARE' group showed an overall lower risk of significant patient-prosthesis mismatch among 9 studies (OR 0.472, 95% CI 0.295-0.756; P = 0.002) and a higher overall difference in means of indexed effective orifice area among 10 studies (random-effect model: 0.06 cm2/m2, 95% CI 0.029-0.103; P < 0.001). Conclusions: Surgical ARE seems to be associated with increased perioperative mortality but with lower risk of patient-prosthesis mismatch. (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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