Management of the dissected aortic root in young patients: A propensity score-matched analysis of mechanical versus bioprosthetic aortic root replacement.

OBJECTIVE

Valve selection in acute type A aortic dissection (ATAAD) requiring aortic root replacement is challenging given the clinical acuity, unknown patient preferences, risk of surgical bleeding, and limited life expectancy. We sought to identify long-term outcomes of mechanical versus bioprosthetic aortic root replacement in young patients with ATAAD.

METHODS

Retrospective review of our institution's database of ATAAD was conducted to identify patients aged 65 years and younger who underwent mechanical Bentall (mech-Bentall) or bioprosthetic Bentall (bio-Bentall) for ATAAD from 2002 to 2022. The primary end point was 10-year survival, which was compared in a propensity score-matched cohort and multivariable Cox proportional hazards model. A composite outcome of 10-year freedom from death, stroke, major bleeding, and valvular reintervention was assessed as a secondary end point.

RESULTS

Of 1114 patients who underwent ATAAD repair, there were 79 mech-Bentalls and 67 bio-Bentalls in patients aged 65 years or younger. Patients undergoing mech-Bentall were younger, and they were less likely to undergo an extended arch operation; there was no difference in gender, race, comorbidities, or malperfusion on presentation. In a propensity score-matched analysis, mech-Bentall patients demonstrated a nonsignificant increase in 10-year mortality ( = .058) and demonstrated higher rates of the composite end point ( = .026). In a Cox proportional hazards model, mech-Bentall (hazard ratio, 1.892; = .023) was independently associated with 10-year composite end point occurrence.

CONCLUSIONS

There is no survival advantage of mech-Bentall in ATAAD in young patients at 10 years, and it is associated with a significantly higher rate of morbid complications. When the aortic valve cannot be spared, bio-Bentall should be considered in ATAAD, even in young patients.