Clinical Outcomes of Root Reimplantation and Bentall Procedure: Propensity Score Matching Analysis

Abstract

This study aimed to evaluate the clinical outcomes of aortic root replacement (ARR) surgery: Root reimplantation as valve-sparing root replacement (VSR) and the Bentall procedure. We retrospectively reviewed 216 patients who underwent ARR between 1995 and 2013 at Samsung Medical Center. Patients were divided into two groups, depending on the procedure they underwent: Bentall (n= 134) or VSR (n= 82). The mean follow-up duration was 100.9 ± 56.4 months. There were 2 early deaths in the Bentall group and none in the VSR group (p= 0.53). Early morbidities were not different between the groups. Overall mortality was significantly lower in the VSR group (HR= 0.12, p= 0.04). Despite the higher reoperation rate in the VSR group (p= 0.03), major adverse valve-related events (MAVRE) did not differ between the groups (p= 0.28). Bleeding events were significantly higher in the Bentall group during follow-up (10 in Bentall group, 0 in VSR group, p= 0.04). There were 6 thromboembolic events only in the Bentall group (p= 0.11). We performed a propensity score matching analysis comparing the groups (134 Bentall versus 43 VSR). Matched analysis gave similar results, namely, HR= 0.17, p= 0.10 for overall mortality and HR= 1.01, p= 0.99 for MAVRE. Although there was marginal significance in the propensity matched analysis, it is plausible to anticipate a survival benefit with VSR during long-term follow-up. Despite a higher reoperation for aortic valves, VSR can be a viable option in patients who decline life-long anticoagulation, especially the young or the patients in whom anticoagulation is contraindicated.