Valve-sparing approaches and valved conduits for aortic root surgery in patients with Marfan syndrome. Meta-analysis of immediate and long-term results

DOI: https://doi.org/10.17116/Cardiobulletin20241904113
Keywords: Marfan syndrome, aortic root, David procedure, Bentall procedure, meta-analysis

Abstract

Valve-sparing procedures in aortic root surgery demonstrate favorable short-term and long-term results. At the same time, the feasibility of valve-sparing procedures in patients with Marfan syndrome is questionable. This meta-analysis compares the immediate
and long-term results of valve-sparing approaches and valved conduits in aortic root surgery for patients with Marfan syndrome.
Data searching was performed in the MEDLINE, Embase, Cochrane and Web of Science databases. The primary endpoints were
redo surgery rate and mortality in long-term period. Long-term aortic insufficiency (AI) +3/+4 was also estimated as a primary endpoint. Secondary endpoints included surgery for acute aortic dissection type A, 30-day mortality, thromboembolism, endocarditis and bleeding. Meta-analysis was carried out in accordance with the PRISMA recommendations 2020. In-hospital mortality
was similar (OR 3.46; 95% CI 0.92—12.92; I2=0%; p=0.07). In long-term period, thromboembolism (OR 2.77; 95% CI 1.44—5.33;
I2=0%; p=0.002), endocarditis (OR 3.19; 95% CI 1.18—8.61; I2=0%; p=0.02), bleeding (OR 3.46; 95% CI 1.76—6.77; I2=0%;
p=0.0003) and mortality (OR 3.18; 95% CI 1.8—5.63; I2=12%; p<0.0001) were significantly more common after implantation
of valved conduits. In long-term period, aortic insufficiency +3/+4 was more common after reimplantation (OR 0.17; 95% CI 0.05—
0.52; I2=5%; p=0.002). In our study, valve-sparing procedures have advantage regarding the incidence of postoperative complications and mortality. However, long-term freedom from severe aortic insufficiency was higher after implantation of valved conduits

Author Biographies

Isaev Ruslan , Sechenov First Moscow State Medical University

Assistant, Department of Faculty Surgery No. 1, Candidate of Medical Sciences

Komarov Roman , Sechenov First Moscow State Medical University

Post: Director of the Clinic, Doctor of Cardiovascular Surgery, MD of the Clinic and Department: Cardiac Surgery Department / Clinic of Cardiovascular Surgery Work experience: 2000 - Pavlovskaya Central District Hospital of Nizhny Novgorod region, surgeon  2007 - 2012 - Russian National Research Center named after Academician of B.V. Petrovsky Russian Academy of Medical Sciences, Department of Surgery of the Aorta and its Branches, Senior Researcher 2012 - 2015 - I.M. Sechenov First Moscow State Medical University, Professor of the Department of Cardiovascular Surgery and Invasive Cardiology, Head. Department of Aortic Surgery, Deputy Director of the University Clinic of Aortic and Cardiovascular Surgery 2013-2015 - Head of the Research Department of Heart, Aorta and Vascular Surgery 2013-2015 - Executive Secretary of the Journal Cardiology and Cardiovascular Surgery 2015 - present - I.M. Sechenov First Moscow State Medical University, Director of the Clinic of Aortic and Cardiovascular Surgery, Head of the Department of Cardiovascular Surgery and Invasive Cardiology, Head of the Department of Aortic Surgery, Deputy Editor-in-Chief of the Journal Cardiology and Cardiovascular Surgery Education 2000 - Diploma with honors from Nizhny Novgorod State Medical Academy, specialty "Medical Treatment" 2002 - clinical residency Nizhny Novgorod State Medical Academy specializing in Surgery 2003 - retraining Nizhny Novgorod State Medical Academy in the specialty "Cardiovascular surgery" 2007 - surgeon of the highest qualification category Research interests Doctor of Medical Sciences, Professor. Doctoral dissertation on "Ways to improve the results of treatment of patients with thoracoabdominal aortic aneurysms". He is the author of 5 monographs, 7 patents for inventions and more than 250 scientific papers. Deputy Editor-in-Chief of the Journal Cardiology and Cardiovascular Surgery. He is a member of the Association of Cardiovascular Surgeons of Russia, the Russian Society of Angiologists and Vascular Surgeons. He was awarded a Certificate of Honor from the Department of Health of the Nizhny Novgorod Region in 2006, and a Certificate of Honor from the Administration of the Pavlovsky District of the Nizhny Novgorod Region in 2006. In 2008, he was awarded a grant from the Regional Public Foundation for the Promotion of Public Medicine of the Presidium of the Russian Academy of Medical Sciences in the nomination "Clinical Medicine". Laureate of the N.I. Pirogov Russian Academy of Medical Sciences Prize in medicine for a cycle of work in the field of aortic surgery (2010), nominee of the First All-Russian Award in the field of oncology "in vita veritas" for achievement of the year in the field of oncosurgery (2011). Areas of professional expertise: - coronary heart disease - mitral valve prolapse - aortic valve stenosis - insufficiency of the heart valves - mitral valve insufficiency - pulmonary artery valve stenosis - mitral valve stenosis - aortic aneurysm - reconstructive surgery for tumor lesions of the heart and major vessels ★ Winner of the All-Russian Prodoctors Award-2024 among cardiac surgeons ★ Winner of the All-Russian Prodoctors Award-2023 among cardiac surgeons

Torchinsky Nikolai , Sechenov First Moscow State Medical University

Department of Epidemiology and Evidence-based Medicine, Ph.D.

Gerasimov Andrey , Institute of Epidemiology

Doctor of Physical and Mathematical Sciences, Leading Researcher at the Scientific Group of Mathematical Methods and Epidemiological Forecasting, Department of Molecular Diagnostics and Epidemiology, Central Research Institute of Epidemiology; Head of the Department of Medical Informatics and Statistics of the Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

Polibin Roman , Sechenov First Moscow State Medical University

Department of Epidemiology and Evidence-Based Medicine, Sechenov University; F.F. Institute of Public Health Erisman, Deputy Director for Scientific Work, Ph.D.

Vyazovichenko Yuri , Sechenov First Moscow State Medical University

Department of Epidemiology and Evidence-based Medicine, MD, Professor

Tkachev Maxim, Sechenov First Moscow State Medical University

Department of Cardiovascular Surgery, Candidate of Medical Sciences

Belov Yuri , Sechenov First Moscow State Medical University

Department of Hospital Surgery, Head of the Department, MD.

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Published
2025-03-08
How to Cite
Isaev, R., Komarov, R., Torchinsky, N., Gerasimov , A., Polibin, R., Vyazovichenko , Y., Tkachev , M., & Belov , Y. (2025). Valve-sparing approaches and valved conduits for aortic root surgery in patients with Marfan syndrome. Meta-analysis of immediate and long-term results. Russian Cardiology Bulletin / Kardiologicheskii Vestnik, 19(4 часть 1), 13-32. https://doi.org/10.17116/Cardiobulletin20241904113
Issue
Vol. 19 No. 4 часть 1 (2024)
Section
Review articles