Long-term outcomes of valve-sparing aortic root versus composite aortic valve graft replacement for aortic root aneurysm: Meta-analysis of reconstructed time-to-event data

Background: We aimed to evaluate the long-term outcomes of valve-sparing aortic root replacement (VSARR) versus composite aortic valve graft replacement (CAVGR) for aortic root aneurysms. Methods: Meta-analysis of Kaplan-Meier-derived time-to-event data from studies with follow-up including propensity-score matching or propensity-score adjustment. Results: Six studies met our eligibility criteria, comprising 3215 patients (1770 patients treated with VSARR and 1445 patients with CAVGR). We observed a statistically significant difference for overall survival favoring VSARR (HR 0.63, 95%CI 0.49-0.82, P = 0.001), but no statistically significant difference in the risk of reoperation (HR 0.77, 95%CI 0.51-1.14, P = 0.187) in the overall follow-up. Landmark analyses revealed that, in the first 10 years after the procedure, reoperation rates were comparable between VSARR and CAVGR (HR 0.96, 95%CI 0.62-1.48, p = 0.861), but the results beyond 10 years showed improved rates of freedom from reoperation in patients undergoing VSARR (HR 0.10, 95%CI 0.01-0.78; p = 0.027). Conclusion: VSARR seems to confer better long-term survival and lower risk of reoperation in the follow-up of patients treated for aortic root aneurysm when compared with CAVGR.