Clinical Outcomes of the David V Valve-Sparing Root Replacement Compared With Bioprosthetic Valve-Conduits for Aortic Root Aneurysms

Background Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. Limited insight exists when the results of VSRR are compared with those of conventional root replacement with use of a bioprosthetic composite conduit (BIO). This study compares the operative and midterm results of VSRR and BIO. Methods A retrospective review from 2002 to 2015 at a United States academic center identified 282 patients who underwent VSRR and 425 patients who underwent BIO. Propensity-score matching was performed based on 20 preoperative characteristics, and 123 matched pairs were identified. Results The mean age (VSRR 53.5 ± 11.1, BIO 53.0 ± 13.0; p  = 0.74) and left ventricular ejection fraction (VSRR 54.5 ± 9.2%, BIO 54.4 ± 9.4%; p  = 0.99) were equivalent in both groups. The incidence of bicuspid valves (VSRR 26.0%, BIO 27.6%; p  = 0.77), Marfan syndrome (VSRR 6.5%, BIO 4.9%; p  = 0.58), type A dissection (VSRR 13.0%, BIO 13.0%; p  = 0.99), reoperation (VSRR 15.4%, BIO 20.3%; p  = 0.32) and arch replacement (VSRR 60.2%, BIO 63.4%; p  = 0.60) were similar between the groups. Operative mortality was 5.7% in VSRR and 0.8% in BIO ( p  = 0.07). There were no significant differences in postoperative renal failure (VSRR 0.8%, BIO 0.0%; p  = 0.99) or stroke (VSRR 3.3%, BIO 0.8%; p  = 0.37) between the groups. The 7-year survival (VSSR 82.4%, BIO 83.0%; p  = 0.53), 7-year freedom from reoperation (VSRR 97.4%, BIO 95.8%; p  = 0.48), and 7-year freedom from greater than moderate aortic insufficiency (AI) (VSRR 98.1%, BIO 100.0%; p  = 0.47) were similar between groups. Conclusions VSRR and BIO result in equivalent operative mortality and morbidity with similar midterm survival and valve durability. VSRR is an effective alternative to BIO for aortic root pathologic conditions; however, careful patient selection is paramount.