Reimplantation versus remodeling in valve-sparing surgery for aortic root aneurysms: a meta-analysis

BACKGROUND: Valve-sparing aortic root replacement (VSARR), which includes reimplantation and remodeling techniques, has been developed as an important treatment for aortic root aneurysms. We aimed to evaluate the outcomes of reimplantation versus remodeling techniques in valve-sparing surgery for aortic root aneurysms. METHODS: A systematic review and meta-analysis was performed by searching PubMed, Embase and the Cochrane Library until November 2019. Fourteen retrospective cohort studies comparing reimplantation with remodeling techniques for aortic root aneurysms were included and contained at least one of the following outcomes: early mortality, late mortality, aortic valve-related reoperation, and postoperative moderate to severe aortic regurgitation (AR). RESULTS: The outcomes of 1,672 patients (1,011 underwent reimplantation surgery, and 661 underwent remodeling) were analyzed. Compared with remodeling, the reimplantation technique was associated with a significantly lower risk of late mortality (RR =0.34; 95% CI, 0.17–0.71; P=0.004; I(2)=37%) and reoperation (RR =0.31; 95% CI, 0.12–0.76; P=0.01; I(2)=55%). There was no significant difference in early mortality (RR =0.69; 95% CI, 0.31–1.53; P=0.36; I(2)=0%), postoperative moderate to severe AR (RR =0.64; 95% CI, 0.31–1.32; P=0.22; I(2)=36%) or postoperative stroke (RR =1.26; 95% CI, 0.58–2.75; P=0.56; I(2)=0%) between the two groups. No evidence of publication bias was detected. CONCLUSIONS: The current meta-analysis indicate that patients who undergo reimplantation procedures have a significantly lower risk of late mortality and reoperation than those who undergo remodeling procedures. Early mortality, postoperative moderate to severe AR and stroke were comparable between the two techniques.