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Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients.

Abstract：

OBJECTIVES:This study sought to evaluate the impact of surgical aortic root enlargement (ARE) on the perioperative outcomes of aortic valve replacement (AVR). METHODS:Databases were searched for studies published until April 2018 to carry out a systematic review followed by meta-analysis of results. RESULTS:The search yielded 1468 studies for inclusion. Of these, 10 articles were analysed and their data extracted. A total of 13 174 patients (AVR with ARE: 2819 patients; AVR without ARE: 10 355 patients) were included from studies published from 2002 to 2018. The total rate of ARE was 21.4%, varying in the studies from 5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)] for perioperative mortality showed a statistically significant difference between the groups (among 10 studies), with a higher risk in the 'AVR with ARE' group (OR 1.506, 95% CI 1.209-1.875; P < 0.001), but not when adjusted for isolated AVR + ARE without any concomitant procedures such as mitral valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95% CI 0.968-2.726; P = 0.066-among 6 studies). The 'AVR with ARE' group showed an overall lower risk of significant patient-prosthesis mismatch among 9 studies (OR 0.472, 95% CI 0.295-0.756; P = 0.002) and a higher overall difference in means of indexed effective orifice area among 10 studies (random-effect model: 0.06 cm2/m2, 95% CI 0.029-0.103; P < 0.001). CONCLUSIONS:Surgical ARE seems to be associated with increased perioperative mortality but with lower risk of patient-prosthesis mismatch.

journal_name

Interact Cardiovasc Thorac Surg

journal_title

Interactive cardiovascular and thoracic surgery

authors

Sá MPBO,Carvalho MMB,Sobral Filho DC,Cavalcanti LRP,Diniz RGS,Rayol SC,Soares AMMN,Sá FBCA,Menezes AM,Clavel MA,Pibarot P,Lima RC

doi

10.1093/icvts/ivy364

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

74-82

issue

1

eissn

1569-9293

issn

1569-9285

pii

5303694

journal_volume

29

pub_type

杂志文章,meta分析,评审

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