Outcomes and risks of elective and urgent aortic root surgery for aortic aneurysms similar in expert hands

UK: If conducted by an experienced team using a consistent perioperative strategy, aortic root replacement (ARR) and valve-sparing root replacement (VSRR) can be accomplished with low mortality and morbidity, as well as a low rate of reintervention over the time of long-term follow-up, reveals a study published in the BMJ journal Heart. 

Aortic root aneurysms are surgically treated with the reimplantation VSRR procedure. The aneurysm is treated while the patient's native aortic valve is maintained using this procedure.

This research was carried out by Marjan Jahangiri and her colleagues. To assess the short- and long-term results of the conventional aortic root and valve-sparing root replacement utilizing a standard perioperative and surgical strategy.

This study presents data from 609 consecutive patients who underwent elective and urgent aortic root surgery (470 ARR, 139 VSRR) between 2006 and 2020. The primary outcomes were surgical mortality and postoperative complication rates. Long-term survival and the need for reintervention were secondary outcomes. The average length of follow-up was 7.6 years (range: 0.5–14.5).

The key findings of this study were as follows:

1. 189 patients, (31%) developed bicuspid aortic valves, and 17 (6.9%) required redo surgeries.

2. The median time for a cross-clamp was 88 minutes, with a cardiopulmonary bypass period of 108 minutes.

3. In-hospital mortality was 10% (1.6%), with 1.1% having transient ischemic attacks/strokes.

4. The VSRR in-hospital mortality rate was 0.7%. For bleeding, 12 patients (2.0%) underwent a resternotomy, while 14 (2.3%) got hemofiltration.

5. The length of stay in the intensive care unit and the hospital was 1.7 and 7.0 days, respectively.

6. During follow-up, 1.4% of the VSRR group had redo surgery for native aortic valve replacement.

7. Overall survival was 95.1% after three years, 93.1% after five years, 91.2% after seven years, and 88.6% after ten years.

In conclusion, this series includes current research to weigh the dangers of aortic aneurysms and their burst at 5.5 cm diameters against the benefits and risks of surgery.

Reference:

Jahangiri, M., Mani, K., Acharya, M., Bilkhu, R., Quinton, P., Schroeder, F., Morgan, R., & Edsell, M. (2022). Early and long-term outcomes of conventional and valve-sparing aortic root replacement. In Heart (p. heartjnl-2022-320870). BMJ. https://doi.org/10.1136/heartjnl-2022-320870