SynthesisJournal of cardiothoracic surgery2025
Aortic root replacement versus preservation in acute type A aortic dissection repair: meta-analysis of reconstructed time-to-event data.
Synthesis in Journal of cardiothoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOutcomes of aortic root replacement (ARR) versus conservative root approach (CRA) in patients undergoing acute type A aortic dissection (ATAAD) repair remained controversy.
methodsThe present study was a pooled meta-analysis of Kaplan-Meier-derived individual patient data (IPD) from comparative studies published by September 29, 2024.
resultsForty studies met our eligibility criteria, comprising 11,734 patients (4212 in the ARR group and 7522 in the CRA group). In the overall population, the overall survival was similar between the ARR and CRA groups (hazard ratio [HR], 0.95; 95% CI, 0.87-1.02; p = 0.17, log-rank test p = 0.47), while ARR was associated with lower risk of reoperation compared with CRA (HR 0.72; 95% CI, 0.59-0.87; p < 0.001, log-rank test p < 0.001). Subgroup analysis revealed that valve-sparing root replacement (VSRR) was associated with better overall survival compared with CRA (HR 0.74; 95% CI, 0.60-0.91; p = 0.004, log-rank test p = 0.003), while Bentall procedure was not (HR 1.06; 95% CI, 0.93-1.20; p = 0.37, log-rank test p = 0.39). The restricted mean survival time (RMST) was overall 12.9 months longer with VSRR compared with CRA (p = 0.009). The meta-regression analyses did not find statistically significant coefficients for the covariates of age, male sex, hypertension, diabetes, Marfan syndrome, bicuspid aortic valve, aortic root diameter and ascending aorta diameter in the CRA arm.
conclusionsIn patients underwent ATAAD repair, the overall survival was comparable between ARR and CRA, while ARR was associated with lower risk of reoperation compared with CRA. VSRR was associated with better long-term survival compared with CRA, while Bentall procedure was not.
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