Abstract 10952: Valve-Sparing Root Replacement in Patients With Bicuspid Aortic Valves versus Patients With Tricuspid Aortic Valves: A Meta-Analysis

Abstract

Objective: Valve-sparing root replacement (VSRR) has been described as a treatment for aortic root dilation and aortic regurgitation (AR) in both patients with tricuspid aortic valves (TAVs) and bicuspid aortic valves (BAVs); however, varied results have been reported regarding the long term need for re-intervention and subsequent aortic regurgitation in patients with BAVs. Thus, we conducted a meta-analysis to compare the outcomes of VSRR in patients with BAVs versus patients with TAVs. Methods: PubMed was searched through April 2022 to identify all studies reporting comparative outcomes of VSRR in patients with BAVs versus patients with TAVs. Short term outcomes of interest were in-hospital mortality, reoperation for bleeding, and stroke and long term outcomes of interest were long-term mortality, freedom from reoperation, and freedom from AR ≥ 2. Results: Our analysis included 13 studies reporting outcomes of 2909 patients undergoing VSRR (n = 861 for BAV group and n = 2048 for TAV group), including 9 retrospective and 4 prospective single-institution cohort studies. No significant differences were observed in terms of in-hospital mortality (hazard ratio [HR] [95% confidence interval [CI]] = 0.49 [0.18-1.35]; P = 0.17; I 2 = 0%), reoperation for bleeding (HR [95% CI] = 1.06 [0.66-1.73]; P = 0.80; I 2 = 0%), stroke (HR [95% CI] = 2.40 [0.77-7.44]; P = 0.13; I 2 = 0%), and freedom from AR ≥ 2 (HR [95% CI] = 1.60 [0.69-3.72]; P = 0.28; I 2 = 49%), though there was a trend toward greater rates of stroke and freedom from AR ≥ 2 in the TAV group. However, there were significantly lower rates of long-term mortality (HR [95% CI] = 0.47 [0.30-0.74]; P = 0.001; I 2 = 0%) and higher rates of reoperation (HR [95% CI] = 2.11 [1.26,3.54]; P = 0.004; I 2 = 19%) in the BAV group. Conclusion: VSRR can be performed in patients with BAVs with similar short term outcomes and lower rates of long-term mortality compared to patients with TAV; however, greater rates of reoperation may be observed in BAV patients.