BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic ...BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.展开更多
Background: Alteration of arterial mechanical properties has adverse effects on cardiovascular disease in Marfan syndrome. Design: We compared central pulse pressure, augmentation index adjusted to a heart rate of 75 ...Background: Alteration of arterial mechanical properties has adverse effects on cardiovascular disease in Marfan syndrome. Design: We compared central pulse pressure, augmentation index adjusted to a heart rate of 75 beats per minute (AIx@HR75) and pulse wave velocity in 25 Marfan patients who had under-gone an aortic valve-sparing reimplantation operation, in 15 Marfan patients after composite valve grafting operation, and in 40 age and sex-matched Mar-fan patients who had not undergone surgery. Results: Central pulse pressure, AIx@HR75 and pulse wave velocity were similar across all three patient groups. Exclusively AIx@HR75 was higher with conduit operations than in persons without any surgery (P = 0.03). Multivariate linear regression analysis documented association of AIx@HR75 with body height (P < 0.001) and with a history of aortic valve-sparing reimplantation operation (P < 0.001) or with a composite valve grafting operation (P = 0.006). Conclusions: Arterial mechanical properties are only mildly altered by surgery of the aortic root without difference between the reimplantation and conduit operation.展开更多
文摘BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.
文摘Background: Alteration of arterial mechanical properties has adverse effects on cardiovascular disease in Marfan syndrome. Design: We compared central pulse pressure, augmentation index adjusted to a heart rate of 75 beats per minute (AIx@HR75) and pulse wave velocity in 25 Marfan patients who had under-gone an aortic valve-sparing reimplantation operation, in 15 Marfan patients after composite valve grafting operation, and in 40 age and sex-matched Mar-fan patients who had not undergone surgery. Results: Central pulse pressure, AIx@HR75 and pulse wave velocity were similar across all three patient groups. Exclusively AIx@HR75 was higher with conduit operations than in persons without any surgery (P = 0.03). Multivariate linear regression analysis documented association of AIx@HR75 with body height (P < 0.001) and with a history of aortic valve-sparing reimplantation operation (P < 0.001) or with a composite valve grafting operation (P = 0.006). Conclusions: Arterial mechanical properties are only mildly altered by surgery of the aortic root without difference between the reimplantation and conduit operation.
