Aortic root operation for aortic aneurysm: Valve replacement versus valve sparing procedures

Background

Aortic root replacement (Bentall operation) or Aortic valve sparing (David operation) are alternative surgical techniques for the treatment of aortic root aneurysm. The aim of the current study was to compare our 30-days mortality, post-operative care and complications associated with both procedures.

Methods

From January 2015 to December 2017, 45 consecutive patients (40 men; 88.9%), with mean age 43.2 ± 6.55 years underwent either Bentall operation (Group A: 30 patients; 66.7%) or David operation (Group B: 15 patients; 33.3%); according to surgeons' preference or expertise.

Group A patients were significantly older (47.1 ± 7.6 vs. 39.3 ± 5.5 years; P = 0.001), more hypertensive (10 patients; 33.3% vs. none; P = 0.019), had higher serum creatinine level (1.3 ± 0.28 vs. 39.3 ± 5.5 vs. 1.07 ± 0.12 mg/dl; P = 0.004), larger LVEDD (6.03 ± 0.4 vs. 5.40 ± 0.16 cm; P < 0.001) and lower EF% (56.6 ± 6.31 vs. 61.3 ± 3.51; P = 0.011) but needed shorter aortic cross clamp (101.8 ± 19.9 vs. 200 ± 16.9 min; P = 0.011) and bypass times (151.68 ± 17.2 vs. 266.6 ± 25.8 min; P < 0.001); compared to Group B.

Results

Overall 30-day mortality was 6.7% in both groups: 2 patients in Group A and 1 patient in Group B. Mortalities were significantly older (54.3 ± 7.23 vs. 43.9 ± 7.6 years; P = 0.025), had larger aortic root (71.6 ± 1.31 vs. 61.2 + 0.78 cm: P = 0.037) and left ventricular end diastolic diameters (6.37 ± 0.68 vs. 5.79 ± 0.44 cm; P < 0.038), needed prolonged mechanical ventilation (51.67 ± 24.39 vs. 92.33 ± 19.66 h; P = 0.007) and ICU stay (5.07 ± 1.98 vs. 8.33 ± 1.53 days; P = 0.008); compared to survivors. Group B patients had significantly longer aortic cross clamp and bypass times but showed Although 4 group B patients showed severe residual aortic regurge, compared to none in Group A (P = 0.23), yet. Other hospital complications were equally comparable.

Conclusion

Factors affecting our 30-days mortality were related to the severity of the disease. Both procedures could be valid alternatives, yet more cases of residual aortic regurge are expected with David operation, especially in the early learning curve.