Valve-Sparing Aortic Root Replacement for Type A Aortic Dissection

Valve-sparing aortic root replacement (VSRR) for acute type A aortic dissections (ATAADs) vs composite aortic valve graft replacement (CAVGR) shows no statistically significant difference in overall survival over time, however a higher risk of reoperations is associated with VSRR, according to study findings published in the International Journal of Cardiology.

Investigators sought to assess treatment of ATAADs, comparing long-term freedom from reoperation and overall survival in VSRR and CAVGR. They conducted a meta-analysis of reconstructed time-to-event data from 7 studies found in a database search of Cochrane Controlled Trials Register, LILACS, SciELO, EMBASE, and PubMed through December 2022 without language restriction and assessed by 2 independent reviewers.

They included 858 patients (n=367, VSRR; n=491, CAVGR). Included studies had populations who had received TAAD surgical intervention, with an intervention group receiving VSRR, a second intervention group receiving CAVGR, follow-up with survival/mortality rates and/or need for reoperation, and were designed as a randomized controlled or observational trial.

Overall, study population mean ages ranged from 37 to 67 years, were predominantly men, with significant prevalence of additional surgical procedures (total arch replacement, hemi-arch replacement, coronary artery bypass).

Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool which found overall risk of bias to be moderate-to-high (leaning to the high-side) with the most serious risk of bias due to confounding followed by selection bias.

Between groups, overall survival showed no statistically significant difference (hazard ratio (HR), 0.83; 95% CI, 0.63-1.10; P =.192) over time. The VSRR group vs the CAVGR group had a higher risk of reoperation (HR, 9.99; 95% CI, 2.23-44.73; P =.003).

Age had a modulating effect on the outcome, with a statistically significant positive coefficient in meta-regression (in VSRR vs CAVGR for overall mortality, the higher the mean age, the higher the HR). Outcomes were unaffected by concomitant coronary bypass surgery, concomitant hemi-arch and/or total arch replacement, history of connective tissue disorders, diabetes, hypertension, or female sex.

Limitations of the study include use of data from observational studies susceptible to biases, variations in surgeons’ expertise, incompleteness of follow-up, and poor representation of older patients.

 “VSARR [VSRR] did not confer a better (or worse) survival over time in patients with ATAAD, but it was associated with higher risk of reoperations in the long run,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.