The influence of Marfans and bicuspid valves on outcomes following aortic valve reimplantation

Martín, Cristina; Montero, Carlos; Serrano, Santiago-Fiz; González, A.; Mingo, Susana; Moñivas, Vanessa; Centeno, Jorge Antônio Silva; Forteza, Alberto

doi:10.1111/jocs.13206

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…The selection procedure of this systematic review is shown in Figure 1. A total number of 44 studies matched with the inclusion and exclusion criteria and were included for analysis, of which 11 publications separately reported (partially) outcomes on TAV (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and 12 publications on BAV (7,17,20,21,(25)(26)(27)(28)(29)(30)(31)(32). The full list of studies included in this review is presented in the Supplementary material (Appendix 3).…”

Section: Resultsmentioning

confidence: 99%

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Mastrobuoni,

Govers,

Veen

et al. 2023

Ann Cardiothorac Surg

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Background Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. Methods We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. Results Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. Conclusions This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs.

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Section: Resultsmentioning

confidence: 99%

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Mastrobuoni,

Govers,

Veen

et al. 2023

Ann Cardiothorac Surg

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“…Eighty-five percent of patients underwent the David procedure, versus the Yacoub. Of the included papers, nine studies reported freedom from mortality curves ( 14 , 15 , 17 , 18 , 20 , 25 , 27 , 28 ), and 15 studies reported freedom from secondary reoperation curves ( 14 - 21 , 24 - 30 ) amenable to aggregated KM analysis. Six studies were deemed to be of moderate risk of bias, with those remaining as low risk ( 15 - 17 , 24 , 26 , 30 ) (see Figure S2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies were deemed to be of moderate risk of bias, with those remaining as low risk ( 15 - 17 , 24 , 26 , 30 ) (see Figure S2 ). All studies were determined to be of high quality on quality assessment, with the exception of 5 ( 15 , 18 , 19 , 28 , 30 ) which were deemed of moderate quality. Baseline patient demographic data for medical comorbidities were poorly reported across all included studies, with insufficient data reported for meta-analysis for type 2 diabetes mellitus, hypertension, coronary artery disease, peripheral vascular/arterial disease, chronic obstructive pulmonary disease/emphysema, and smoking history.…”

Section: Resultsmentioning

confidence: 99%

“…Following removal of duplicate and irrelevant studies, 76 studies were assessed for full-text eligibility. Nineteen retrospective cohort studies were included in the final meta-analysis (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Baseline patient demographic data and included perioperative data are presented in Table 1 and Table 2.…”

Section: Resultsmentioning

confidence: 99%

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The outcomes of three decades of the David and Yacoub procedures in bicuspid aortic valve patients—a systematic review and meta-analysis

Wilson-Smith¹,

Wilson-Smith²,

Smith³

et al. 2023

Ann Cardiothorac Surg

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Background Valve-sparing aortic procedures, including the David and Yacoub procedures, have emerged as the dominant approaches in aortic aneurysm surgery, preserving the native aortic valve and thereby conferring significant prognostic benefits to the patient. Over the years, these procedures have also shown promise in patients with bicuspid valve-related aortopathy. This systematic review and meta-analysis presents the most up-to-date data on perioperative outcomes, freedom from secondary reoperation, and freedom from mortality for bicuspid valve patients undergoing valve-sparing aortic operations. Methods The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Four databases were searched, ultimately yielding 19 papers for inclusion, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied. Kaplan-Meier curves were digitized and aggregated using previously validated techniques. Results A total of 1,159 patients were included. Males accounted for 87.4% of the cohort. The mean age of the cohort was 44.9 years. The mean aortic root diameter was estimated to be 46.3 mm, with an estimated range from 38 to 54 mm. Thirty-day mortality rate was estimated to be 1.7%. Eighty-five percent of patients in this series received the David approach, with the remainder receiving the Yacoub approach. Overall, there was low heterogeneity observed for the mean length of intensive care stay, while high heterogeneity was observed for the other remaining variables of interest. Kaplan-Meier survival estimation at 5, 10, and 15 years was 96%, 90%, and 87%, respectively. Kaplan-Meier freedom from secondary reoperation at 5, 10, and 15 years was 96%, 91%, and 88%, respectively. Conclusions This review demonstrates the durability and safety of the David and Yacoub valve-sparing procedures across long-term follow-up in bicuspid aortic valve patients. These procedures offer significant freedom from mortality and secondary reoperations on the aorta and valve and will likely continue to demonstrate excellent results into the future. There is a clear transition towards the David procedure, with the bulk of contemporary literature publishing on this technique.

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Cirugía conservadora de la válvula aórtica en la dilatación de la raíz aórtica

Martínez-López

Gil

2023

Cirugía Cardiovascular

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The influence of Marfans and bicuspid valves on outcomes following aortic valve reimplantation

Abstract: The reimplantation technique for aortic root aneurysms is associated with excellent clinical and functional outcomes at short and mid-term follow-up.

Cited by 6 publications

References 32 publications

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

The outcomes of three decades of the David and Yacoub procedures in bicuspid aortic valve patients—a systematic review and meta-analysis

Cirugía conservadora de la válvula aórtica en la dilatación de la raíz aórtica

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