Comparative outcomes of aortic root preservation versus root replacement for acute type A aortic dissection: balancing survival, durability, and reoperation.

OBJECTIVE

We reviewed the available literature on patients undergoing aortic repair for acute type A aortic dissection (ATAAD) with either aortic root preservation (RP) or root replacement (RR).

METHODS

Original research studies that evaluated the long-term outcomes of the RP versus RR group were identified from 2000 to 2025. Median overall survival (OS) was the primary endpoint. Reoperation-free OS was the secondary endpoint. Sensitivity analyses were performed including risk-adjusted populations, subgroups, and using the leave-one-out method.

RESULTS

Seventeen studies were included in the qualitative and quantitative synthesis, incorporating data from 7569 patients with a follow-up period of up to 25 years. According to our analysis, RP (4266 patients) demonstrated higher OS compared to RR (2589 patients) groups (HR: 0.83; 95% CI:0.76, 0.91; p < 0.01). The median OS was 13.57 years for the RP group and 13.48 years for the RR group. Nonetheless, the reoperation-free OS was higher in the RR group (HR: 1.39; 95% CI: 1.16, 1.67; p < 0.01). Valve-sparing RR (VSRR) demonstrated the highest long-term OS (p < 0.05).

CONCLUSION

RP is associated with superior OS but a higher risk of reoperation, while RR offers greater durability with fewer reoperations, and VSRR may provide the optimal balance of longevity and native valve preservation, warranting further prospective studies.