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Aortic Root Surgery in Marfan Syndrome: comparison of valve-sparing versus total root replacement. A Meta-analysis.

Aortic Root Surgery in Marfan Syndrome: comparison of valve-sparing versus total root replacement. A Meta-analysis. Angeloni E, Benedetto U, Refice S, Capuano F, Roscitano A, Sinatra R. University of Rome “La Sapienza” Department of Cardiac Surgery, Ospedale Sant’Andrea, Roma. Background.

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Aortic Root Surgery in Marfan Syndrome: comparison of valve-sparing versus total root replacement. A Meta-analysis.

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  1. Aortic Root Surgery in Marfan Syndrome:comparison of valve-sparing versus total root replacement.A Meta-analysis. Angeloni E, Benedetto U, Refice S, Capuano F, Roscitano A, Sinatra R. University of Rome “La Sapienza” Department of Cardiac Surgery, Ospedale Sant’Andrea, Roma

  2. Background • For decades total root replacement (TRR) with a valved composite graft was the mainstay therapy for aortic root abnormalities in Marfan (MFS) patients. • Complications of TRR: • Anticoagulation therapy (thrombo-embolism, hemorrhage) • Endocarditis

  3. Background • Aortic valve sparing techniques (VS), introduced by Yacoub (’79) and David (’88), avoid the need for anticouagulation • Potential deterioration of preserved leaflets raises concern over the durability of VS in MFS patients

  4. Objective • Lack of definitive evidence about durability of VS in MFS • 1 on-going , Multi-Center study, but only preliminary results on early outcome are available • We conducted a Meta-Analysis on available retrospective series

  5. Methods • Web-base search engine (PubMed and Ovid) • On March 04, 2010, a PubMed and EMBASE search of (Valve sparing OR valve preserving) OR (bentall OR root replacement OR composite valve graft) OR (aortic root surgery) AND (marfan)was conducted, limited to publications about humans. In addition, the entire Cochrane library wassearched for (valve sparing) OR (valve preserving)OR (Bentall) OR (composite valve graft) OR (aortic root surgery) AND (marfan) in title, abstract, or key words ofpublications. • Retrieved 530 papers • Only 45 papers reported data of aortic root surgery in MFS pts • Of those, 33 articles were excluded because one of the following: • Less than 30 patients per arm • Not possible extracting data because of design of the study (eg Dissection vs. Aneurysm) • Data from same Institution in the same period (overlapping)

  6. Methods • 12 articles included in the study (1434 pts) • Both arms of 2 comparative studies • Single arms of 4 comparative studies (for which arm updated available in literature) • 3 studies reporting data only of VS procedures on MFS patients • 3 studies reporting data only of TRR procedures on MFS patients

  7. Studies included

  8. Results

  9. Results – Heterogeneity Test

  10. Conclusions • VS provides significant advantages in thrombo-embolic events and mortality rates when compared to TRR in MFS patients • Overall valve-related complications rates did not differ significantly • VS was associated with a significant increase in the rate of reintervention • Reintervention rate was lower in those with >70% of pts. receiving David operation • Thus far, evidence indicates that is feasible and safe for MFS patients, but concern remains about its durability

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