Our Summary

This research paper compares two methods of heart surgery for patients with aortic root aneurysm, a condition where the root of the aorta (the main artery that carries blood from the heart to the rest of the body) bulges or swells. The two methods are valve-sparing aortic root replacement (VSARR), where the aortic valve is preserved, and valve-replacing aortic root replacement (VRARR), where the aortic valve is replaced.

The study involved 475 patients who underwent either VSARR or VRARR between 2007 and 2019. Researchers used a method called propensity score-matching to ensure a fair comparison between the two groups.

The researchers found no significant difference in the rate of major complications or deaths within 30 days of surgery. However, patients who underwent VSARR had a higher survival rate after 8 years (100% vs. 88.9% in the VRARR group).

The rate of needing another surgery on the valve was about the same for both groups. There was also no significant difference in the rate of severe aortic regurgitation (a condition where the aortic valve doesn’t close tightly, causing blood to leak back into the heart) after 8 years. However, the VSARR group had better results on a measure of how well the aortic valve was working (mean valve gradients) at the last follow-up.

In summary, the study suggests that VSARR is a safe operation for patients with aortic root aneurysm and nonstenotic aortic valves when performed by experienced surgeons. The need for reoperation is similar for both methods, but the way the aortic valve fails differs between the two groups.

FAQs

  1. What is the difference between Valve-sparing aortic root replacement (VSARR) and valve-replacing aortic root replacement (VRARR)?
  2. What were the key findings in the comparison between VSARR and VRARR procedures based on the study?
  3. Is Valve-sparing aortic root replacement (VSARR) considered a safe operation for patients with aortic root aneurysm and nonstenotic aortic valves?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about valve replacement is to follow a healthy lifestyle and maintain regular follow-up appointments with your healthcare provider. It is important to take any prescribed medications as directed, and to report any new symptoms or changes in your health to your doctor promptly. Additionally, participating in cardiac rehabilitation and following a heart-healthy diet can help improve outcomes and recovery after valve replacement surgery.

Suitable For

Patients with aortic root aneurysm without aortic stenosis, including those with Marfan syndrome or bicuspid aortic valve, are typically recommended valve replacement procedures such as valve-sparing aortic root replacement (VSARR) or valve-replacing aortic root replacement (VRARR). These procedures are performed by experienced surgeons and have been shown to have good outcomes in terms of survival, freedom from reoperation, aortic regurgitation, and valve gradients.

Timeline

  • Before valve replacement:
  1. Patient presents with aortic root aneurysm without aortic stenosis.
  2. Patient undergoes evaluation and assessment for the need of valve-sparing aortic root replacement (VSARR) or valve-replacing aortic root replacement (VRARR).
  3. Decision is made to proceed with either VSARR or VRARR based on guidelines and patient’s specific condition.
  4. Surgery is scheduled and patient undergoes pre-operative preparation and counseling.
  • After valve replacement:
  1. Patient undergoes VSARR or VRARR procedure.
  2. Post-operative recovery period with monitoring for any complications.
  3. Follow-up appointments to assess recovery and monitor valve function.
  4. Long-term follow-up to monitor for valve durability, aortic regurgitation, valve gradients, and need for reoperation.
  5. Comparison of outcomes between VSARR and VRARR, with findings including higher overall survival in the VSARR group, similar freedom from reoperation, and better mean valve gradients in the VSARR group.
  6. Conclusion that VSARR is a safe operation in patients with aortic root aneurysm and nonstenotic aortic valves, with experienced surgeons.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with valve-sparing aortic root replacement and valve-replacing aortic root replacement?
  2. How experienced are you in performing valve-sparing aortic root replacement procedures?
  3. What is the expected recovery time and rehabilitation process after valve replacement surgery?
  4. How often will I need follow-up appointments to monitor my valve function after surgery?
  5. What lifestyle changes or restrictions should I follow after valve replacement surgery?
  6. How long can I expect the replacement valve to last before needing another surgery?
  7. What symptoms should I watch for that may indicate a problem with the replacement valve?
  8. Are there any specific medications I will need to take after valve replacement surgery?
  9. Will I need any additional procedures or treatments in the future related to the valve replacement surgery?
  10. Are there any alternative treatment options to valve replacement that I should consider?

Reference

Authors: Malaisrie SC, Kislitsina ON, Wilsbacher L, Mendelson M, Puthumana JJ, Vassallo P, Kruse J, Andrei AC, McCarthy PM. Journal: J Card Surg. 2022 Jul;37(7):1947-1956. doi: 10.1111/jocs.16473. Epub 2022 Apr 5. PMID: 35384050