Valve-Sparing Vs Bio-Bentall Aortic Root Replacement in Patients Aged 60 to 75 Years: Survival, Reintervention, and Aortic Regurgitation

Background: Valve-sparing root replacement (VSRR) with the David technique is an established therapy for aortic root pathology in young patients. This study evaluated short- and long-term outcomes between VSRR and aortic root replacement (ARR) with a biological-valved conduit in sexagenarians.

Methods: A multicenter retrospective review from 2002 to 2022 identified 299 sexagenarians undergoing aortic root surgery, among whom 82 (27.4%) underwent VSRR and 217 (72.6%) underwent bio-Bentall. Inverse probability of treatment weighting (IPTW) was applied to balance clinical variables. Median follow-up was 15 years (interquartile range, 12-18 years). Study end points were in-hospital mortality, long-term survival, freedom from reintervention, and recurrence of at least moderate aortic regurgitation (AR).

Results: There were no major differences in baseline characteristics. The incidence of bicuspid valves (VSRR, 4.9%; ARR, 19%), severe AR (42% vs 51%), type A aortic dissection (1.2% vs 6.9%), and reoperation (4% vs 23%) were higher in ARR. After IPTW, there was no difference in in-hospital mortality (VSRR, 1.2%; ARR, 4.6%; P = .3). The incidence of neurologic complications (P = .003) and permanent pacemaker implantation (P = .022) were significantly higher in the bio-Bentall group. After IPTW, 10-year survival did not differ between VSRR (87%) and ARR (80%; P = .176). However, cardiac survival was significantly higher in VSRR patients (98% vs 92%, P = .018), with deaths mainly due to infective endocarditis and end-stage heart failure. No difference was reported in reoperation/recurrence of at least moderate AR among the groups at 10 years, with only 1 patient undergoing reintervention after bio-Bentall (P = .117).

Conclusions: David and bio-Bentall procedures have low in-hospital mortality and good long-term survival in sexagenarians. VSRR is associated with improved long-term cardiac survival, lower rates of infective endocarditis, permanent pacemaker implantation, and heart failure episodes, with similar rates of reintervention/recurrence of moderate AR.