Assessment of short- and long-term outcomes of aortic valve-sparing operation at concomitant aortic root and arch repair.

Objectives: Concomitant aortic root and arch replacement is a complex procedure. Although valve-sparing root replacement may offer advantages over valve prostheses, the decision to spare the valve may increase the risk profile of this procedure. This study examines the safety of aortic valve-sparing operation in such settings.

Methods: All patients who underwent concomitant aortic root and arch replacement between 2004 and 2021 at two aortic centres were reviewed. Patients with aortic stenosis, endocarditis or a history of previous cardiac surgery were excluded. Inverse probability treatment weighting yielded well-balanced cohorts. The primary end-points were mortality and complications during the index hospital stay, and secondary end-points were long-term survival and aortic valve reintervention rate.

Results: A total of 764 patients who underwent concomitant aortic root and arch replacement, including valve-sparing root replacement (n = 311) or composite valve graft root replacement (n = 453), were analysed. Surgical indication was dissection in 155 (20.2%), and distal extension was total arch replacement in 50 (6.5%). Cardiopulmonary bypass and cross-clamp times were longer in valve-sparing root replacement (P = 0.006 and P < 0.001, respectively). Valve-sparing root replacement demonstrated comparable in-hospital mortality rates (2.5% vs 4.9%, P = 0.195) and showed higher long-term survival rates (P = 0.04) (12-year survival rate; 78.5% [71.7-86.1%] vs 64.2% [57.4-71.6%]), which was reconfirmed on multivariable Cox regression analysis (hazard ratio: 0.505 [0.348-0.734], P < 0.001). The cumulative incidence of reintervention was similar in both groups (P = 0.62).

Conclusions: In appropriately selected patients requiring aortic root and arch replacement, a valve-sparing operation may be performed safely without increased operative risk.