Long term outcomes of valve sparing aortic root replacement versus conventional aortic root replacement using a mechanical prosthesis by propensity score matching

This study aimed to compare the early and long-term postoperative outcomes of valve-sparing and Bio-Glue–reinforced non-valve-sparing aortic root replacement surgeries in patients diagnosed with aortic root aneurysms and/or aortic dissection. A total of 107 patients, aged 15 to 84, diagnosed with aortic root aneurysm and/or aortic dissection, underwent aortic root replacement using either the David procedure (n = 30) or the Bio-Glue–reinforced modified Bentall procedure (n = 77). All surgeries were performed by the same surgical team at a tertiary university hospital’s cardiovascular surgery clinic between April 2007 and April 2018. The patients’ preoperative characteristics, early postoperative outcomes, and long-term results were retrospectively reviewed. Further analyses were conducted after propensity-score matching to evaluate survival outcomes. Among the 30 patients who underwent the David procedure, 4 required reoperation due to aortic insufficiency (13.3%). In contrast, no reoperation was required in the Bentall group due to aortic valve pathology (p = 0.001). Survival analysis showed similar 30-day survival rates between the groups; however, after propensity-score matching, the Bentall group demonstrated significantly higher long-term survival compared to the David group (96.7 vs. 76.7%, p = 0.005). Valve-sparing techniques, such as the David procedure, have a higher reoperation rate compared to non-valve-sparing techniques like the modified Bentall procedure. While the valve-sparing David procedure achieves good outcomes, the Bio-Glue–reinforced modified Bentall procedure should be recognized for its comparable and potentially superior long-term survival outcomes.