title: The David V Valve-Sparing Root Replacement Provides Improved Survival Compared With Mechanical Valve-conduits in the Treatment of Young Patients With Aortic Root Pathology.
abstract: BACKGROUND
  Valve-sparing root replacement (VSRR) is an attractive therapy for aortic root aneurysms; however, there is a paucity of data comparing VSRR with conventional root replacement using a mechanical valve-conduit (MECH). This study evaluates and compares outcomes of VSRR and MECH.
  
  
  METHODS
  A retrospective review from 2002 to 2015 at a US academic center identified 444 patients who underwent VSRR (282 patients) or MECH (162 patients). Propensity score matching was performed, based on 22 preoperative and intraoperative characteristics, and 87 matched pairs were identified.
  
  
  RESULTS
  There was no difference in mean age between the groups (VSRR 45.0 years, MECH 44.2 years, p = 0.59). The incidence of Marfan syndrome (VSRR 10.3%, MECH 12.6%, p = 0.63), type A acute aortic dissection (VSRR 25.3%, MECH 27.6%, p = 0.73), reoperation (VSRR 23.0%, MECH 21.8%, p = 0.86), and arch replacement (VSRR 54.0%, MECH 52.9%, p = 0.88) were similar in both groups. Ejection fraction was similar (VSRR 52.8% ± 10.9%, MECH 52.4% ± 11.7%, p = 0.83). Operative mortality was 2.3% with VSRR and 8.0% with MECH (p = 0.10). There were no significant differences in renal failure requiring dialysis (VSRR 1.1%, MECH 4.6%, p = 0.24), permanent neurologic dysfunction (VSRR 2.3%, MECH 6.9%, p = 0.16), and pacemaker implantation (VSRR 1.1%, MECH 1.1%, p = 0.99) between the groups. Survival at 7 years was significantly improved in patients who underwent VSSR (VSRR 85.5%, MECH 73.6%, p = 0.03).
  
  
  CONCLUSIONS
  In comparison with patients undergoing MECH, there is improved midterm survival among patients undergoing VSRR, with similar operative mortality and morbidity. For appropriately selected patients, VSRR provides an attractive and potentially superior alternative to MECH.
authors.affiliation: Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Esaki
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Leshnower
authors.affiliation: Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Binongo
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lasanajak
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: LaRonica
authors.initials: L
authors.lastname: McPherson
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: edward.p.chen@emory.edu.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization / Q000379:methods; D015897:Comorbidity; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D012092:Replantation; D012107:Research Design; D012189:Retrospective Studies; D013536:Suture Techniques