Conventional aortic root vs valve-sparing root replacement surgery in aortic dilatation syndromes: a comparison of mortality and postoperative complications

ABSTRACT

Introduction

Conventional aortic root and valve-sparing root replacement surgery are two current surgical treatments for aortic dilatation syndromes. This review article aims to review the current literature surrounding these two established techniques.

Areas covered

This review article will address the current indications for valve-sparing root replacement surgery, technical considerations in surgical planning and a comparison of clinical outcomes between these two surgical techniques.

Expert opinion

Valve-sparing root replacement surgery is a safe and established treatment for aortic syndromes. Valve-sparing surgery procedure avoids the inherent risk of prosthetic valve dysfunction and prosthesis infection by preserving the native aortic valve compared to conventional aortic root surgery. This has been demonstrated in various observational studies and should be considered in clinically and anatomically appropriate patients. Other technical considerations, such as reimplantation versus remodeling technique and aortic cusp repair in select patients, may impact in short-term procedural and long-term clinical success with valve-sparing surgery.

KEYWORDS:

• Aortopathy
• aortic valve surgery
• cardiac surgery
• valve-sparing root replacement surgery
• David procedure
• Bentall procedure
• Yacoub procedure

Article highlights

• Valve-sparing root replacement surgery is an acceptable alternative to conventional aortic root replacement surgery for treating aortic insufficiency with or without aortic root dilatation.

• There is a paucity of prospective head-to-head comparisons or randomised trials examining the efficacy or safety of valve-replacement root replacement surgery.

• Current evidence is limited to single-center or pooled analyses of observational studies.

• Valve-sparing root replacement surgery appears to be associated with lower long-term mortality than conventional aortic root replacement surgery.

• The reimplantation (David’s) technique appears to be associated with lower mortality and repeat operations than the remodelling (Yacoub’s) technique, though these studies had limitations due to variable follow-up periods and the retrospective nature of all the studies.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.