Valve‐sparing versus valve‐replacing aortic root replacement in patients with aortic root aneurysm

摘要

Abstract Background Valve‐sparing aortic root replacement (VSARR) is an alternative to valve‐replacing aortic root replacement (VRARR) with valved‐conduits based on recent guidelines for clinical practice. This study investigated outcomes of these two procedures in patients with nonstenotic valves. Methods Between January 7, 2007 and June 30, 2019, 475 patients with aortic root aneurysm without aortic stenosis underwent VSARR (151) or VRARR (324) techniques. Propensity score‐matching (PSM) was used to alleviate confounding. Endpoints were 30‐day mortality, 8‐year survival and reoperation, aortic regurgitation, and valve gradients. Results PSM created 69 pairs of patients with a mean age 52?±?13 years (10.1 Marfan syndrome, 34.8 bicuspid aortic valve). There was no statistically significant difference in major perioperative morbidity or 30‐day mortality (0 VSARR vs.?1.4 VRARR; p?=?0.316). Overall survival was significantly higher (p?=?0.025) in the VSARR group versus the VRARR group (8‐year estimates 100 vs. 88.9, respectively), while freedom from valve reoperation was similar (p?=?0.97, 8‐year estimates 90.9 vs. 96.7, respectively). Freedom from > moderate‐severe AR was not significantly different (p?=?0.08, 8‐year estimates 90.0 VSARR group vs. 100 VRARR), but mean valve gradients at last follow‐up were better in the VSARR group (5.9 vs. 13.2?mmHg, p?