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Journal of Cardiothoracic Surgery

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Open Access 01-12-2023 | Review

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis

Authors: Yiding Zuo, Ruixi Tan, Chaoyi Qin

Published in: Journal of Cardiothoracic Surgery | Issue 1/2023

Abstract

Background

Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).

Design

Meta-analysis with meta-regression and systematic review.

Setting

Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase.

Interventions

All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes.

Result

Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I² = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I² = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I² = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time.

Conclusion

The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.

David TE. Aortic root aneurysms: remodeling or composite replacement? Ann Thorac Surg. 1997;64:1564–8.CrossRefPubMed

Mokashi SA, Rosinski BF, Desai MY, Griffin BP, Hammer DF, Kalahasti V, Johnston DR, Rajeswaran J, Roselli EE, Blackstone EH, Svensson LG. Aortic root replacement with bicuspid valve reimplantation: Are outcomes and valve durability comparable to those of tricuspid valve reimplantation? J Thorac Cardiovasc Surg. 2022;163:51–63.CrossRefPubMed

David TE, David CM, Feindel CM, Manlhiot C. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg. 2017;153:232–8.CrossRefPubMed

Klotz S, Stock S, Sievers HH, Diwoky M, Petersen M, Stierle U, Richardt D. Survival and reoperation pattern after 20 years of experience with aortic valve-sparing root replacement in patients with tricuspid and bicuspid valves. J Thorac Cardiovasc Surg. 2018;155:1403–11.CrossRefPubMed

Zhou Z, Liang M, Huang S, Wu Z. Reimplantation versus remodeling in valve-sparing surgery for aortic root aneurysms: a meta-analysis. J Thorac Dis. 2020;12:4742–53.CrossRefPubMedPubMedCentral

Schafers HJ, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, Aicher D. Reexamining remodeling. J Thorac Cardiovasc Surg. 2015;149:S30–6.CrossRefPubMed

David TE, David CM, Ouzounian M, Feindel CM, Lafreniere-Roula M. A progress report on reimplantation of the aortic valve. J Thorac Cardiovasc Surg. 2021;161:890–9.CrossRefPubMed

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Qual Report Meta Anal Lancet. 1999;354:1896–900.

D. Moher, A. Liberati, J. Tetzlaff, D.G. Altman, P. Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.CrossRef

10.

Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.CrossRefPubMedPubMedCentral

11.

Aicher D, Langer F, Lausberg H, Bierbach B, Schafers HJ. Aortic root remodeling: ten-year experience with 274 patients. J Thorac Cardiovasc Surg. 2007;134:909–15.CrossRefPubMed

12.

Malvindi PG, Raffa GM, Basciu A, Citterio E, Cappai A, Ornaghi D, Tarelli G, Settepani F. Bicuspidy does not affect reoperation risk following aortic valve reimplantation. Interact Cardiovasc Thorac Surg. 2012;14:717–20.CrossRefPubMedPubMedCentral

13.

Kvitting JP, Kari FA, Fischbein MP, Liang DH, Beraud AS, Stephens EH, Mitchell RS, Miller DC. David valve-sparing aortic root replacement: equivalent mid-term outcome for different valve types with or without connective tissue disorder. J Thorac Cardiovasc Surg. 2013;145:117–26 (discussion 126–7).CrossRefPubMed

14.

Bavaria JE, Desai N, Szeto WY, Komlo C, Rhode T, Wallen T, Vallabhajosyula P. Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure. J Thorac Cardiovasc Surg. 2015;149:S22–8.CrossRefPubMed

15.

Martin CE, Garcia Montero C, Serrano SF, Gonzalez A, Mingo S, Monivas V, Centeno J, Forteza A. The influence of Marfans and bicuspid valves on outcomes following aortic valve reimplantation. J Card Surg. 2017;32:604–12.CrossRefPubMed

16.

Shrestha ML, Beckmann E, Abd Alhadi F, Krueger H, Meyer-Bockenkamp F, Bertele S, Koigeldiyev N, Kaufeld T, Fleissner F, Korte W, Schmitto J, Cebotari S, Harringer W, Haverich A, Martens A. Elective David I procedure has excellent long-term results: 20-year single-center experience. Ann Thorac Surg. 2018;105:731–8.CrossRefPubMed

17.

Karciauskas D, Mizariene V, Jakuska P, Ereminiene E, Orda P, Ordiene R, Vaskelyte JJ, Nedzelskiene I, Kinduris S, Benetis R. Early and long-term results of aortic valve sparing aortic root reimplantation surgery for bicuspid and tricuspid aortic valves. Perfusion. 2019;34:482–9.CrossRefPubMed

18.

Ouzounian M, Feindel CM, Manlhiot C, David C, David TE. Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves. J Thorac Cardiovasc Surg. 2019;158:1–9.CrossRefPubMed

19.

Miyahara S, Karliova I, Giebels C, Schneider U, Matsushima S, Schafers HJ. Aortic root remodeling in bicuspid and tricuspid aortic valves-long-term results. Indian J Thorac Cardiovasc Surg. 2020;36:81–7.CrossRefPubMed

20.

David TE. Current readings: aortic valve-sparing operations. Semin Thorac Cardiovasc Surg. 2014;26:231–8.CrossRefPubMed

21.

Sef D, Bahrami T, Raja SG, Klokocovnik T. Current trends in minimally invasive valve-sparing aortic root replacement-Best available evidence. J Card Surg. 2022;37:1684–90.CrossRefPubMed

22.

David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–21 (discussion 622).CrossRefPubMed

23.

Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.CrossRefPubMed

24.

Schill MR, Kachroo P. Surgical options for aortic root aneurysm disease: which procedure, which patient. Curr Opin Cardiol. 2021;36:683–8.CrossRefPubMed

25.

David TE, Ivanov J, Armstrong S, Feindel CM, Webb GD. Aortic valve-sparing operations in patients with aneurysms of the aortic root or ascending aorta. Ann Thorac Surg. 2002;74:S1758-61 (discussion S1792–9).CrossRefPubMed

26.

Vohra HA, Whistance RN, De Kerchove L, Punjabi P, El Khoury G. Valve-preserving surgery on the bicuspid aortic valve. Eur J Cardiothorac Surg. 2013;43:888–98.CrossRefPubMed

27.

Ashikhmina E, Sundt TM 3rd, Dearani JA, Connolly HM, Li Z, Schaff HV. Repair of the bicuspid aortic valve: a viable alternative to replacement with a bioprosthesis. J Thorac Cardiovasc Surg. 2010;139:1395–401.CrossRefPubMed

28.

Svensson LG, Al Kindi AH, Vivacqua A, Pettersson GB, Gillinov AM, Mihaljevic T, Roselli EE, Sabik JF 3rd, Griffin B, Hammer DF, Rodriguez L, Williams SJ, Blackstone EH, Lytle BW. Long-term durability of bicuspid aortic valve repair. Ann Thorac Surg. 2014;97:1539–47 (discussion 1548).CrossRefPubMed

29.

Kalra K, Wagh K, Wei JW, McPherson L, Binongo JN, Leshnower BG, Chen EP. Regurgitant bicuspid aortopathy: is valve-sparing root replacement equivalent to Bentall procedure? Ann Thorac Surg. 2021;112:737–45.CrossRefPubMed

30.

Kari FA, Doll KN, Hemmer W, Liebrich M, Sievers HH, Richardt D, Reichenspurner H, Detter C, Siepe M, Czerny M, Beyersdorf F. Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients. Interact Cardiovasc Thorac Surg. 2016;22:431–8.CrossRefPubMed

31.

Boodhwani M, de Kerchove L, Glineur D, Rubay J, Vanoverschelde JL, Noirhomme P, El Khoury G. Repair of regurgitant bicuspid aortic valves: a systematic approach. J Thorac Cardiovasc Surg. 2010;140:276–84.CrossRefPubMed

32.

Schafers HJ, Aicher D, Langer F, Lausberg HF. Preservation of the bicuspid aortic valve. Ann Thorac Surg. 2007;83:S740-5 (discussion S785–90).CrossRefPubMed

33.

Schafers HJ, Aicher D. Root remodeling for aortic root dilatation. Ann Cardiothorac Surg. 2013;2:113–6.PubMedPubMedCentral

34.

Gocol R, Bis J, Malinowski M, Ciosek J, Hudziak D, Morkisz L, Jasinski M, Deja MA. Comparison of bicuspid and tricuspid aortic valve repair. Eur J Cardiothorac Surg. 2021;59:1183–90.CrossRefPubMed

35.

Vallabhajosyula P, Komlo C, Szeto WY, Wallen TJ, Desai N, Bavaria JE. Root stabilization of the repaired bicuspid aortic valve: subcommissural annuloplasty versus root reimplantation. Ann Thorac Surg. 2014;97:1227–34.CrossRefPubMed

36.

Lee H, Cho YH, Sung K, Kim WS, Park KH, Jeong DS, Park PW, Lee YT. Clinical outcomes of root reimplantation and bentall procedure: propensity score matching analysis. Ann Thorac Surg. 2018;106:539–47.CrossRefPubMed

37.

Bethancourt CN, Blitzer D, Yamabe T, Zhao Y, Nguyen S, Nitta S, Kelebeyev S, Borger MA, Kurlansky PA, George I, Smith C, Takayama H. Valve-sparing root replacement versus bio-bentall: inverse propensity weighting of 796 patients. Ann Thorac Surg. 2022;113:1529–35.CrossRefPubMed

Title: Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis
Authors: Yiding Zuo
Ruixi Tan
Chaoyi Qin
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2023
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-023-02329-8

2024 ASCO Annual Meeting

Springer Medicine

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis

Abstract

Background

Design

Setting

Interventions

Result

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Design

Setting

Interventions

Result

Conclusion

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