Can Valve-Sparing Aortic Root Replacement Outperform The Bentall Procedure in Acute Type A Aortic Dissection? A Decade-Long Meta-Analysis Update
DOI:
https://doi.org/10.21831/jomassh.v2i1.2058Keywords:
Aortic root aneurysm, Bentall, valve-sparing, surgical strategy, aortic dissectionAbstract
Introduction: Aortic root replacement (ARR) is crucial in managing acute type A aortic dissection with aortic root involvement. While Bentall procedure is widely utilized, valvesparing aortic root replacement (VSRR) offers the advantage of native valve preservation, albeit with technical challenges and longer operative time. This study compares VSRR and Bentall outcomes in AAAD patients. This study aims to evaluate the comparative effectiveness of VSRR versus the Bentall procedure in AAAD. Methods: A systematic review and meta-analysis was conducted using Cochrane, PubMed, and ScienceDirect databases for studies published between 2014 and 2024. Outcomes assessed included acute kidney injury (AKI), stroke, gastrointestinal bleeding, atrial fibrillation (AF), 30-day mortality, ICU stay, and reoperation rates. Data were pooled with random-effects or fixed-effect models based on heterogeneity, reporting odds ratios or mean differences with 95% confidence intervals. Result: Twelve studies involving 3237 patients (1610 VSRR, 1627 Bentall) were analyzed. VSRR significantly reduced the risk of AKI (OR 0.75; 95%CI 0.60-0.91), reduced ICU stay (MD -2.92 days; 95%CI -4.00 to -1.84), reduce the odds of 30-days mortality (OR 0.43, 95%CI 0.20-0.95), and AF (OR 0.40, 95%CI 0.22-0.71) compared to Bentall. No significant differences were found in gastrointestinal bleeding, stroke, hospital stay, or in-hospital mortality. VSRR also reduced valve-related reoperation risk (OR 0.59; 95%CI 0.39-0.91). Conclusion: VSRR shows promising outcomes in AAAD, particularly in reducing AKI, ICU stay, 30-day mortality, AF, and reoperation risk. VSRR may be a viable option in carefully selected patients, particularly at experienced, high-volume centers.
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