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Background <p>Patients with bicuspid aortic valve (BAV) often develop aortic root aneurysms. While aortic root replacement (Bentall procedure) has been the standard treatment for combined valvular and root pathology, valve-sparing root reimplantation (David procedure) has gained popularity for its potential to preserve the native valve and avoidance of prosthesis related complications. However, comparative data specific to patients with BAV and root aneurysm remain limited. Thus, we aimed to systematically compare the outcomes of the David and Bentall procedures in this anatomically and clinically distinct population.</p> Methods <p>A literature search was conducted in PubMed, Scopus, and Cochrane Library for studies comparing David and Bentall in patients with regurgitant BAV and aortic root aneurysm. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.11.0.</p> Results <p>Four observational studies comprising 679 patients were included, of whom 252 (37.1%) underwent the David procedure. The David procedure was associated with significantly longer cardiopulmonary bypass (CPB) [MD 42.2&#xa0;min; 95% CI 16.7 to 67.6; <i>p</i> = 0.001] and aortic cross-clamp (ACC) time [MD 50.8&#xa0;min; 95% CI 22.8 to 78.8; <i>p</i> &lt; 0.001]. However, due to extreme heterogeneity caution is warranted in interpreting these findings. The David procedure also demonstrated a statistically significant but clinically uncertain reduction in hospital length of stay [MD -1.4&#xa0;days; 95% CI -2.7 to -0.1; <i>p</i> = 0.03] and re-explorations for bleeding [OR 0.4, 95% CI 0.1 to 0.9; <i>p</i> = 0.04]. Other postoperative outcomes, including stroke, arrhythmias, 30-day mortality, and ICU length of stay, were comparable between the two approaches.</p> Conclusions <p>The David procedure may be a viable option in selected BAV patients with root aneurysm. Despite longer CPB and ACC time, it is associated with shorter hospital stays and fewer re-explorations for bleeding, with similar rates of other postoperative outcomes. However, our findings should be interpreted with caution due to the retrospective design of the included studies, strong selection bias, and variability in patient characteristics and surgical techniques. Prospective, multicentre studies with extended follow-ups are needed to validate our results and better define the optimal surgical strategy in this population.</p>

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Valve-sparing aortic root reimplantation versus aortic root replacement in bicuspid aortic valve with aortic root aneurysm: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2025年9月24日

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  • Kristine Santos,
  • Henri Bartolozzi,
  • Ogechukwu Samuel Obi,
  • Ghislain Irakoze Habiyambere,
  • Mihaela Ioana Mariș,
  • Tomasz Płonek

摘要

Background

Patients with bicuspid aortic valve (BAV) often develop aortic root aneurysms. While aortic root replacement (Bentall procedure) has been the standard treatment for combined valvular and root pathology, valve-sparing root reimplantation (David procedure) has gained popularity for its potential to preserve the native valve and avoidance of prosthesis related complications. However, comparative data specific to patients with BAV and root aneurysm remain limited. Thus, we aimed to systematically compare the outcomes of the David and Bentall procedures in this anatomically and clinically distinct population.

Methods

A literature search was conducted in PubMed, Scopus, and Cochrane Library for studies comparing David and Bentall in patients with regurgitant BAV and aortic root aneurysm. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.11.0.

Results

Four observational studies comprising 679 patients were included, of whom 252 (37.1%) underwent the David procedure. The David procedure was associated with significantly longer cardiopulmonary bypass (CPB) [MD 42.2 min; 95% CI 16.7 to 67.6; p = 0.001] and aortic cross-clamp (ACC) time [MD 50.8 min; 95% CI 22.8 to 78.8; p < 0.001]. However, due to extreme heterogeneity caution is warranted in interpreting these findings. The David procedure also demonstrated a statistically significant but clinically uncertain reduction in hospital length of stay [MD -1.4 days; 95% CI -2.7 to -0.1; p = 0.03] and re-explorations for bleeding [OR 0.4, 95% CI 0.1 to 0.9; p = 0.04]. Other postoperative outcomes, including stroke, arrhythmias, 30-day mortality, and ICU length of stay, were comparable between the two approaches.

Conclusions

The David procedure may be a viable option in selected BAV patients with root aneurysm. Despite longer CPB and ACC time, it is associated with shorter hospital stays and fewer re-explorations for bleeding, with similar rates of other postoperative outcomes. However, our findings should be interpreted with caution due to the retrospective design of the included studies, strong selection bias, and variability in patient characteristics and surgical techniques. Prospective, multicentre studies with extended follow-ups are needed to validate our results and better define the optimal surgical strategy in this population.