{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:47:52Z","timestamp":1789264072451,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:00:00Z","timestamp":1564531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"CAMS Initiative for Innovative Medicine","award":["2016-I2M-1\u2013016"],"award-info":[{"award-number":["2016-I2M-1\u2013016"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>There are conflicting views regarding the status of valve-sparing root replacement (VSRR) as a proper treatment for acute type A aortic dissection (AAAD). Our goal was to compare the early and late outcomes of VSRR versus those of the Bentall procedure in patients with AAAD.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We performed a systematic review and meta-analysis of 9 studies to compare the outcomes of VSRR with those of the Bentall procedure in patients with AAAD. We focused on the following issues: early and late mortality rates, re-exploration, thromboembolization\/bleeding events, infective endocarditis and reintervention rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 706 patients with AAAD who underwent aortic root surgery were analysed; 254 patients were treated with VSRR and 452 with the Bentall procedure. VSRR was associated with a reduced risk of early death [odds ratio (OR) 0.34; 95% confidence interval (CI) 0.21\u20130.57] and late death (OR 0.34; 95% CI 0.21\u20130.57) compared with the Bentall procedure. No statistically significant difference was observed between the VSRR and Bentall groups with pooled ORs (OR 0.77; 95% CI 0.47\u20131.27, OR 0.61; 95% CI 0.32\u20131.18 and OR 0.71; 95% CI 0.23\u20132.15) for re-exploration, thromboembolization\/bleeding and postoperative infective endocarditis, respectively. An increased risk of reintervention was observed for the VSRR compared to the Bentall group (OR 3.79; 95% CI 1.27\u201311.30). The pooled rate of reintervention incidence was 1.6% (95% CI 0.0\u20133.7%) and 0.4% (95% CI 0.0\u20131.3%) for the VSRR and the Bentall groups, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>VSRR in patients with AAAD can be performed in experienced centres with excellent short- and long-term outcomes compared to those with the Bentall procedure and thus should be recommended especially for active young patients.<\/jats:p><\/jats:sec>","DOI":"10.1093\/icvts\/ivz180","type":"journal-article","created":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T19:09:29Z","timestamp":1562267369000},"page":"766-775","source":"Crossref","is-referenced-by-count":32,"title":["Is valve-sparing root replacement a safe option in acute type A aortic dissection? A systematic review and meta-analysis"],"prefix":"10.1093","volume":"29","author":[{"given":"Jinlin","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juntao","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Saeed","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuntao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,31]]},"reference":[{"key":"2019102505493286200_ivz180-B1","doi-asserted-by":"crossref","first-page":"176","DOI":"10.4065\/79.2.176","article-title":"Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture","volume":"79","author":"Clouse","year":"2004","journal-title":"Mayo Clin Proc"},{"key":"2019102505493286200_ivz180-B2","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jama.283.7.897","article-title":"The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease","volume":"283","author":"Hagan","year":"2000","journal-title":"JAMA"},{"key":"2019102505493286200_ivz180-B3","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/S0022-5223(19)34942-6","article-title":"An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta","volume":"103","author":"David","year":"1992","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019102505493286200_ivz180-B4","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0022-5223(19)34225-4","article-title":"Remodeling of the aortic valve anulus","volume":"105","author":"Sarsam","year":"1993","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019102505493286200_ivz180-B5","doi-asserted-by":"crossref","first-page":"e1000097.","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"2019102505493286200_ivz180-B6","doi-asserted-by":"crossref","first-page":"j4008.","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"2019102505493286200_ivz180-B7","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"2019102505493286200_ivz180-B8","doi-asserted-by":"crossref","first-page":"45.","DOI":"10.1186\/1471-2288-14-45","article-title":"Newcastle-Ottawa Scale: comparing reviewers\u2019 to authors\u2019 assessments","volume":"14","author":"Lo","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2019102505493286200_ivz180-B9","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1111\/j.0006-341X.2000.00886.x","article-title":"Estimating number of events from the Kaplan-Meier curve for incorporation in a literature-based meta-analysis: what you don\u2019t see you can\u2019t get","volume":"56","author":"Duchateau","year":"2000","journal-title":"Biometrics"},{"key":"2019102505493286200_ivz180-B10","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1016\/S0003-4975(00)01980-9","article-title":"Valve-preserving operation in acute aortic dissection type A","volume":"70","author":"Graeter","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"2019102505493286200_ivz180-B11","doi-asserted-by":"crossref","first-page":"II243","DOI":"10.1161\/01.CIR.0000138948.14144.d6","article-title":"Evolving strategies for treatment of acute aortic dissection type A","volume":"110","author":"Kallenbach","year":"2004","journal-title":"Circulation"},{"key":"2019102505493286200_ivz180-B12","first-page":"31","article-title":"Valve sparing operations for type A aortic dissection: initial experience and early results","volume":"13","author":"Rushdi","year":"2005","journal-title":"J Egypt Soc Cardiothorac Surg"},{"key":"2019102505493286200_ivz180-B13","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1016\/j.crvasa.2012.05.009","article-title":"Aortic valve-sparing operations versus composite graft implantation in acute aortic dissections","volume":"54","author":"Fila","year":"2012","journal-title":"Cor Vasa"},{"key":"2019102505493286200_ivz180-B14","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/j.athoracsur.2012.04.094","article-title":"Valve-sparing root reconstruction does not compromise survival in acute type A aortic dissection","volume":"94","author":"Subramanian","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"2019102505493286200_ivz180-B15","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1055\/s-0035-1552580","article-title":"Is Bentall procedure still the gold standard for acute aortic dissection with aortic root involvement?","volume":"64","author":"Beckmann","year":"2015","journal-title":"Thorac Cardiovasc Surg"},{"key":"2019102505493286200_ivz180-B16","doi-asserted-by":"crossref","first-page":"331","DOI":"10.3109\/14017431.2015.1072236","article-title":"Clinical outcomes of valve-sparing root replacement in acute type A aortic dissection","volume":"49","author":"Lee","year":"2015","journal-title":"Scand Cardiovasc J"},{"key":"2019102505493286200_ivz180-B17","first-page":"719","article-title":"David I versus Bentall in acute type A aortic dissection","volume":"31","author":"Wang","year":"2015","journal-title":"Chin J Thorac Cardiovasc Surg"},{"key":"2019102505493286200_ivz180-B18","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.athoracsur.2017.09.029","article-title":"Sixteen-year experience of David and Bentall procedures in acute type A aortic dissection","volume":"105","author":"Yang","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2019102505493286200_ivz180-B19","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0003-4975(03)00568-X","article-title":"Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival?","volume":"76","author":"Hagl","year":"2003","journal-title":"Ann Thorac Surg"},{"key":"2019102505493286200_ivz180-B20","doi-asserted-by":"crossref","first-page":"443.","DOI":"10.1016\/j.athoracsur.2011.11.003","article-title":"Modified Bentall procedure using two short grafts for coronary reimplantation: long-term results","volume":"93","author":"Maureira","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"2019102505493286200_ivz180-B21","first-page":"473","article-title":"Surgical reconstruction of aortic root in Marfan syndrome patients: a systematic review","volume":"23","author":"Hu","year":"2014","journal-title":"J Heart Valve Dis"},{"key":"2019102505493286200_ivz180-B22","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1136\/hrt.2010.210286","article-title":"Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis","volume":"97","author":"Benedetto","year":"2011","journal-title":"Heart"},{"key":"2019102505493286200_ivz180-B23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.jtcvs.2016.10.081","article-title":"Reimplantation of the aortic valve at 20 years","volume":"153","author":"David","year":"2017","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["Interactive CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/icvts\/article-pdf\/29\/5\/766\/30300384\/ivz180.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/icvts\/article-pdf\/29\/5\/766\/30300384\/ivz180.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T20:33:54Z","timestamp":1575318834000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/29\/5\/766\/5542085"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,31]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,7,31]]},"published-print":{"date-parts":[[2019,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivz180","relation":{},"ISSN":["1569-9285"],"issn-type":[{"value":"1569-9285","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11]]},"published":{"date-parts":[[2019,7,31]]}}}