Valve-Sparing Root Replacement Versus Bio-Bentall: Inverse Propensity Weighting of 796 Patients

Abstract

Background: This large cohort, single-center study compared the 10-year survival and freedom from aortic valve reintervention between valve-sparing root replacement (VSRR) and bioprosthetic Bentall (bio-Bentall).

Methods: All patients undergoing elective VSRR or bio-Bentall for aortic root aneurysm between March 2005 through October 2019 were retrospectively reviewed (N = 796; n = 360 for VSRR). Inverse probability of treatment weighting (IPTW) balanced clinical variables between groups. Mean follow-up was 58.0 ± 45.4 months (range, 0-167 months).

Results: After IPTW adjustment, 10-year survival did not differ between VSRR (87.0%) and bio-Bentall (92.7%, P = 0.780). Cumulative incidence of aortic valve reintervention was 5.9% for VSRR (95% confidence interval [CI], 2.9%-10.4%) and 10.6% for bio-Bentall (95% CI, 6.2%-16.4%; P = .798). A Fine and Gray competing risk regression model identified age at operation (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99; P = .015), body surface area (sHR, 6.21; 95% CI, 1.97-19.59; P = .002), and bicuspid aortic valve (sHR, 2.15; 95% CI, 1.04-4.44; P = .038) as independently associated with aortic valve reintervention. For patients aged 50 years or younger, the cumulative incidence of aortic valve reintervention was 16.2% for VSRR (95% CI, 7.0%-28.8%) and 17.8% for bio-Bentall (95% CI, 6.9%-32.8%; P = .363).

Conclusions: VSRR and bio-Bentall show similar excellent survival and freedom from aortic reintervention rates up to 10 years; however, a durable valve solution for young patients with bicuspid aortic valve remains a challenge.