Valve-Sparing Root Replacement Versus Composite Valve Grafting in Aortic Root Dilation: A Meta-Analysis
| Autor: | Jehangir J. Appoo, Ismail El-Hamamsy, Derrick Y. Tam, Maral Ouzounian, Rodolfo V. Rocha, Mark D. Peterson, Bobby Yanagawa, Malak Elbatarny, Jan O. Friedrich, J. James Edelman, Michael W.A. Chu, Munir Boodhwani |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve medicine.medical_specialty Aortic Diseases 030204 cardiovascular system & hematology Rate ratio 03 medical and health sciences 0302 clinical medicine Bicuspid aortic valve Humans Medicine Myocardial infarction Stroke Heart Valve Prosthesis Implantation integumentary system business.industry medicine.disease Confidence interval Surgery Dissection medicine.anatomical_structure 030228 respiratory system Relative risk Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 110:296-306 |
| ISSN: | 0003-4975 |
| Popis: | Aortic valve-sparing operations theoretically have fewer stroke and bleeding complications but may increase late reoperation risk versus composite valve grafts.We meta-analyzed all studies comparing aortic valve-sparing (reimplantation and remodelling) and composite valve-grafting (bioprosthetic and mechanical) procedures. Early outcomes were all-cause mortality, reoperation for bleeding, myocardial infarction, and thromboembolism/stroke. Long-term outcomes included all-cause mortality, reintervention, bleeding, and thromboembolism/stroke. Studies exclusively investigating dissection or pediatric populations were excluded.A total of 3794 patients who underwent composite valve grafting and 2424 who underwent aortic valve-sparing procedures were included from 9 adjusted and 17 unadjusted observational studies. Mean follow-up was 5.8 ± 3.0 years. Aortic valve sparing was not associated with any difference in early mortality, bleeding, myocardial infarction, or thromboembolic complications. Late mortality was significantly lower after valve sparing (incident risk ratio, 0.68; 95% confidence interval [CI], 0.54-0.87; P.01). Late thromboembolism/stroke (incident rate ratio, 0.36; 95% CI, 0.22-0.60; P.01) and bleeding (incident rate ratio, 0.21; 95% CI, 0.11-0.42; P .01) risks were lower after valve sparing. Procedure type did not affect late reintervention.Aortic valve sparing appears to be safe and associated with reduced late mortality, thromboembolism/stroke, and bleeding compared with composite valve grafting. Late durability is equivalent. Aortic valve sparing should be considered in patients with favorable aortic valve morphology. |
| Databáze: | OpenAIRE |
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