Biological solutions to aortic root replacement: valve-sparing versus bioprosthetic conduit‡.
Valve-sparing operations and root replacement with a biologic composite conduit are viable options in aortic root aneurysm. This study was conceived to compare the early and mid-term results of these 2 procedures.



From September 2002 to November 2015, 749 consecutive patients underwent either a valve-sparing operation or a root replacement with a biologic composite conduit at 2 institutions. Propensity score matching was used to compare similar cohorts of patients in the overall population and in the ≤ 55 and ≥ 65-year age groups.



Overall operative mortality was 0.4%, mean age 57.4 ± 14.3 years, 84.6% were male. Individuals in the biologic composite conduit group were older and had worse preoperative risk profiles [chronic pulmonary disease (5.5% vs 0.9%; P  = 0.001), diabetes (6.4% vs 1.5%; P  = 0.001) and NYHA > 2 (25.2% vs 5.2%; P  < 0.001)]. Mean follow-up was 27.5 ± 28.4 months. In the unmatched population, there was no difference in in-hospital deaths (0 in the valve-sparing versus 3 in the biologic composite conduit group; P  = 0.12). These findings were confirmed in the propensity-matched populations. During follow-up, more patients in the biologic composite conduit group underwent reoperation on the aortic valve (2.6% vs 1.5%; P  = 0.026) resulting in a freedom from reoperation of 97.4% vs 98.5%, respectively. Separate analysis for patients stratified by age revealed no difference in outcomes.



In case of aortic root aneurysm, both valve-sparing operations and root replacement with a biologic composite conduit provide excellent outcomes. However, at mid-term follow-up the use of biologic composite conduit is associated with a higher risk of reoperation.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Mario
M
Gaudino
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Antonino
A
Di Franco
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Lucas B
LB
Ohmes
Department of Cardiac Surgery, European Hospital, Rome, Italy.
Luca
L
Weltert
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Christopher
C
Lau
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Ivancarmine
I
Gambardella
Department of Cardiac Surgery, European Hospital, Rome, Italy.
Andrea
A
Salica
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Monica
M
Munjal
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Mohamed
M
Elsayed
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Leonard N
LN
Girardi
Department of Cardiac Surgery, European Hospital, Rome, Italy.
Ruggero
R
De Paulis
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011474:Prosthesis Design; D016896:Treatment Outcome
Aortic root replacement; Biological prosthesis; Valve-sparing surgery