Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis
Abstract Background Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). Design Me...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-023-02329-8 |
| _version_ | 1827905281932132352 |
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| author | Yiding Zuo Ruixi Tan Chaoyi Qin |
| author_facet | Yiding Zuo Ruixi Tan Chaoyi Qin |
| author_sort | Yiding Zuo |
| collection | DOAJ |
| description | Abstract Background Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). Design Meta-analysis with meta-regression and systematic review. Setting Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. Interventions All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. Result Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. Conclusion The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic. |
| first_indexed | 2024-03-13T00:39:27Z |
| format | Article |
| id | doaj.art-35ee35ccff584bb2b0600bf771cfb7ea |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-13T00:39:27Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-35ee35ccff584bb2b0600bf771cfb7ea2023-07-09T11:24:07ZengBMCJournal of Cardiothoracic Surgery1749-80902023-07-0118111310.1186/s13019-023-02329-8Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysisYiding Zuo0Ruixi Tan1Chaoyi Qin2Department of Anesthesia, West China Hospital, Sichuan UniversityDepartment of Anesthesia, West China Hospital, Sichuan UniversityDepartment of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan UniversityAbstract Background Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). Design Meta-analysis with meta-regression and systematic review. Setting Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. Interventions All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. Result Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. Conclusion The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.https://doi.org/10.1186/s13019-023-02329-8Valve-sparing aortic root replacementReimplantationRemodelingBicuspid aortic valveTricuspid aortic valve |
| spellingShingle | Yiding Zuo Ruixi Tan Chaoyi Qin Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis Journal of Cardiothoracic Surgery Valve-sparing aortic root replacement Reimplantation Remodeling Bicuspid aortic valve Tricuspid aortic valve |
| title | Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis |
| title_full | Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis |
| title_fullStr | Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis |
| title_full_unstemmed | Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis |
| title_short | Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis |
| title_sort | outcomes of valve sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve a systematic review and meta analysis |
| topic | Valve-sparing aortic root replacement Reimplantation Remodeling Bicuspid aortic valve Tricuspid aortic valve |
| url | https://doi.org/10.1186/s13019-023-02329-8 |
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