PT  - JOURNAL ARTICLE
AU  - Lucas Van Hoof
AU  - Marie Lamberigts
AU  - Dries Noé
AU  - Ismail El-Hamamsy
AU  - Emmanuel Lansac
AU  - Jolanda Kluin
AU  - Laurent de Kerchove
AU  - John Pepper
AU  - Tom Treasure
AU  - Bart Meuris
AU  - Filip Rega
AU  - Peter Verbrugghe
ED  - ,
TI  - Matched comparison between external aortic root support and valve-sparing root replacement
AID  - 10.1136/heartjnl-2022-321840
DP  - 2023 Jan 17
TA  - Heart
PG  - heartjnl-2022-321840
4099  - http://heart.bmj.com/content/early/2023/01/17/heartjnl-2022-321840.short
4100  - http://heart.bmj.com/content/early/2023/01/17/heartjnl-2022-321840.full
AB  - Objectives Differences in indication and technique make a randomised comparison between valve-sparing root replacement (VSRR) and personalised external aortic root support (PEARS) challenging. We performed a propensity score (PS)-matched comparison of PEARS and VSRR for syndromic root aneurysm.Methods Patients in the PEARS 200 Database and Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (undergoing VSRR) with connective tissue disease operated electively for root aneurysm <60 mm with aortic regurgitation (AR) <1/4 were included. Using a PS analysis, 80 patients in each cohort were matched. Survival, freedom from reintervention and from AR ≥2/4 were estimated using a Kaplan-Meier analysis.Results Median follow-up was 25 and 55 months for 159 PEARS and 142 VSRR patients. Seven (4.4%) patients undergoing PEARS required an intervention for coronary injury or impingement, resulting in one death (0.6%). After VSRR, there were no early deaths, 10 (7%) reinterventions for bleeding and 1 coronary intervention. Survival for matched cohorts at 5 years was similar (PEARS 98% vs VSRR 99%, p=0.99). There was no difference in freedom from valve or ascending aortic/arch reintervention between matched groups. Freedom from AR ≥2/4 at 5 years in the matched cohorts was 97% for PEARS vs 92% for VSRR (p=0.55). There were no type A dissections.Conclusions VSRR and PEARS offer favourable mid-term survival, freedom from reintervention and preservation of valve function. Both treatments deserve their place in the surgical repertoire, depending on a patient’s disease stage. This study is limited by its retrospective nature and different follow-ups in both cohorts.Data are available upon reasonable request.