title: Aortic valve preservation and repair in acute Type A aortic dissection.
abstract: OBJECTIVE
  Repair and preservation of the aortic valve in Type A aortic dissection (AAD) remains controversial. We performed a meta-analysis of outcomes for aortic valve (AV) repair and preservation in AAD focusing on long-term valve-related events.
  
  
  METHODS
  Structured searches were performed in Embase (1980-2013) and PubMed (1966-2013) for studies reporting AV repair or preservation in AAD. Early mortality and linearized rates for late mortality and valve-related events were derived. Outcome data were pooled with an inverse-variance-weighted random-effects model.
  
  
  RESULTS
  Of 5325 screened articles, 19 observational studies met the eligibility criteria consisting of 2402 patients with a median follow-up of 4.1 [range: 3.1-12.6 years, total 13 733 patient-years (pt-yr)]. The cohort was principally male (median = 68.1%, range: 39-89) with a median age of 59 (range: 55-68) years and Marfan's syndrome was present in 2.5%. AV resuspension was performed in 95% of the patients and the remainder underwent valve-sparing root replacement (reimplantation = 2.5% and remodelling = 2.5%). Pooled early mortality rate was 18.7% [95% confidence interval (95% CI): 12.2-26.2%], and linearized late mortality rate was 4.7%/pt-yr (95% CI: 3.4-6.3). Linearized rate for AV reintervention was 2.1%/pt-yr (95% CI: 1.0-3.6), recurrent aortic insufficiency (>2+) was 0.9%/pt-yr (95% CI: 0.3-2.2) and endocarditis was 0.2%/pt-yr (95% CI: 0.1-0.5). The composite rate of thromboembolism and bleeding was 1.4%/pt-yr (95% CI: 0.7-2.2).
  
  
  CONCLUSIONS
  Patients surviving an AAD have a limited long-term survival. Preservation and repair of the aortic valve is associated with a moderate risk of reoperation, but a low risk of thromboembolism, bleeding and endocarditis.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Saczkowski
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors.forename: Tarek
authors.initials: T
authors.lastname: Malas
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Mesana
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: de Kerchove
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium.
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada mboodhwani@ottawaheart.ca.
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods / Q000401:mortality
keywords: Aortic valve repair; Meta-analysis; Type A aortic dissection; Valve-sparing root replacement