Thorac Cardiovasc Surg 2020; 68(S 01): S1-S72
DOI: 10.1055/s-0040-1705408
Oral Presentations
Tuesday, March 3rd, 2020
Aortic disease
Georg Thieme Verlag KG Stuttgart · New York

Long-Term Single-Center Experience in Aortic Root Surgery: Aortic Valve-Sparing Surgery versus Bentall Procedure

J. Petersen
1   Hamburg, Germany
,
D. Gaekel
1   Hamburg, Germany
,
E. Girdauskas
1   Hamburg, Germany
,
H. Reichenspurner
1   Hamburg, Germany
,
C. Detter
1   Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2020 (online)

Objectives: The main goal in aortic valve-sparing root surgery is to ensure durable aortic valve function without re-intervention. Since the optimal procedure in aortic root surgery remains undefined, the aim of this study was to compare the outcomes of valve-sparing root surgery and Bentall procedures in patients with aortic root aneurysms.

Methods: A total of 430 patients underwent aortic root surgery at our institution between 1997 and August 2019. Patients treated with acute type A aortic dissection were excluded (n = 122). Out of these elective patients, 215 patients received an aortic valve-sparing root surgery (VSRS group; Reimplantation: 300 Remodeling: 13) and 93 a Bentall procedure (Bentall group). Follow-up protocol included clinical interview using a structured questionnaire and long-term echocardiographic follow-up. Time-to-event analyses were calculated using the Kaplan–Meier method. Primary endpoint was actual freedom from aortic valve (AV) reintervention, secondary endpoints were survival and freedom from major adverse cardiac and cerebrovascular events (MACCE).

Results: The VSRS group was significantly younger (48.1 ± 14.8 vs. 61.4 ± 13.4 years; < p < 0.001) and connective tissue disorder was significantly more often present (21.8%) compared to the Bentall group (4.3%; < p < 0.001). Mean follow-up was significantly longer in the Bentall group (78.7 ± 43.8 months vs. 66.1 ± 51.1 months; p = 0.040). In-hospital mortality in the Bentall group was significantly higher (7.7%) compared to the VSRS group (0.7%; < p < 0.001). Overall survival rates at 5, 10, and 15 years were significant higher in the VSRS group (96.6, 88.5, and 85.7%) compared to the Bentall group (88.3, 72.5, and 48.3%; < p < 0.001). Freedom from AV reintervention (VSRS group: 90.0%, 80.0%; Bentall group: 86.3%, 74.7%; p = 0.667) as well as MACCE (VSRS group: 88.4%, 79.4%; Bentall group: 80.3%, 71.9%; p = 0.429) was similar in both groups at 5 and 10 years, respectively.

Conclusion: Aortic valve-sparing root surgery is a safe procedure with very low in-hospital mortality. In this single-center study, in-hospital and long-term mortality was significantly lower in patients with aortic valve-sparing root surgery while aortic-valve related complications were similar in both surgical techniques. Ideally, a randomized multicenter study needs to determine the superior surgical technique in aortic root surgery.