Valve-Sparing Aortic Root Repair Compared to Composite Aortic Root Replacement: A Systematic Review and Meta-Analysis.

Background: Aortic root aneurysms represent a significant risk of morbidity and mortality. Composite root replacement is the preferred practice for repair, although recently valve-sparing replacement has become a popular alternative. The study aim was to identify comparative studies that simultaneously analyzed composite root and valve-sparing root replacement outcomes.

Methods: A systematic review of the current literature was performed through four major databases, from inception until 2016. All comparative studies of valve-sparing versus composite root replacement were identified. All studies were assessed by two reviewers for their applicability and inclusion.

Results: A total of 12 comparative papers was identified encompassing 2,352 patients (700 valve-sparing and 1,652 composite); the mean follow up was 3.7 ± 1.7 years. Aortic cross-clamp and cardiopulmonary bypass times were lower in the composite group (p <0.0001 and p<0.00001, respectively). In-hospital mortality was low, but higher in the composite group (p = 0.002). Only one study reported long-term follow up. In studies reporting reoperation, there was slight difference favoring composite over valve-sparing replacement (p = 0.05).

Conclusions: Valve-sparing and composite root replacement remain feasible options for replacement of the aortic root. Long-term data of comparative studies are not yet available to assess the viability of these procedures.