Леонтьев С. , Borger M.
Heart Center Leipzig;The aim of our study was to compare the short- and long-term outcomes of patients who underwent aortic valve-sparing re-implantation (David) operation (AVr-D) with patients undergoingversus aortic root replacement (Bentall) procedure (ARr-B) operations in a propensity- matched analysis. Methods We compared data of propensity-matched patients who underwent AVvr-D (n = 261) or ARr-B (n = 262) procedures from 2000 to 2015. Propensity score matching was conducted to minimise the effect of confounding variables. Mean age at surgery in the entire cohort was reported as 53 ± 13 years and 19.7% (n = 103) were female. Connective tissue disease was presentvalent in 9.4% (n = 49) of patients, whereas 37.1% (n = 194) presented with a bicuspid aortic valve. Follow-up was complete in 88% of patients. Results The overall 30-day mortality was 1.1% (n = 6) and was not significantly different in patients with AVr-D compared to ARr-B ([0.4%, n = 1] vs [1.9%, n = 5], p = 0.1). Periost-operative strokes occurred in 1.7% of all patients (n = 9) without statistical significance between the two groups (p = 0.31). The 5- and 10- year survival was 93.7% ± 1.8% (AVr-D) vs 93.8% ± 1.6% (ARr-B) and 84.4% ± 4.7% (AVrD) vs 89.5% ± 3.2% (ARr-B) respectively (log rank p = 0.98). Cox regression analysis identified age (HR 1.05; 95% CI 1.02 – 1.08, p < 0.001), smoking (HR 2.76; 95% CI 1.38 – 5.52, p = 0.004) and previous cardiac surgery (HR 4.71; 95% CI 1.79 – 12.36, p = 0.002) as independent predictors of long-term mortality. Re-operation rates did not significantly differ between patient groups (89.5% ± 3.4% vs 87.8% ± 4.1% 10-years postoperatively, log rank p = 0.71). ARr-B patients had a higher rate of serious bleeding during follow up (p = 0.025). Conclusions Both AVr-D and ARr-B are associated with excellent early and long-term results in patients with aortic root aneurysmal disease. AVr-D is associated with equivalent long-term mortality and freedom from reoperation when compared to ARr-B. less bleeding than ARr-B, without an increased risk of reoperation. Because of avoidance of bleeding and other long-term complications associated with prosthetic heart valves, AVr-D is preferable to ARr-B in patients with appropriate pathoanatomy.