Valve-Sparing Aortic Root Replacement versus Composite Graft Combined with Hemiarch Replacement for Acute Type A Aortic Dissection: A Propensity Score Matching Analysis

Background: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic dissection (ATAD) in a propensity score matching analysis.

Methods: In this retrospective study we compared the outcomes before and after propensity score matching of patients who underwent emergency surgical repair for ATAD requiring replacement of the aortic hemiarch with replacement of the aortic root between 2001 and 2023 at our institute. A total of 154 patients were divided into two groups: the first group consisted of patients undergoing David (n = 59), and the second group of patients undergoing Bentall (n = 95) procedures combined with an aortic hemiarch replacement. To reduce the confounding impact of preoperative variables in this non-randomized study 1:1 propensity score matching using the Nearest-Neighbor Matching algorithm was used.

Results: Patients in the David plus Hemiarch group were significantly younger compared with the Bentall plus Hemiarch group (62.16 ± 12.35 vs. 55.55 ± 10.80, p = 0.001). After a propensity score matching there were no significant differences between the two groups regarding intraoperative variables and in-hospital outcomes. In-hospital death was 15% (n = 6) in the David plus Hemiarch group compared with 24% (n = 10) in the Bentall plus Hemiarch group (15% vs. 24%, p = 0.40). Operation time was also similar between both groups, being 402 and 384 minutes respectively. Survival analyses also didn’t show any difference in long-term survival between both groups.

Conclusion: When a standardized hemiarch replacement is used, no significant differences in short- and long-term outcomes were observed between a valve-sparing procedure and composite graft replacement in patients undergoing surgical repair for ATAD. Surgeons should opt for the surgical strategy they are most comfortable with.

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Artikel online veröffentlicht:
11. Februar 2025