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dc.contributor.authorBurton, S
dc.contributor.authorReynolds, AC
dc.contributor.authorKing, N
dc.contributor.authorModi, A
dc.contributor.authorAsopa, S
dc.date.accessioned2024-01-24T11:07:40Z
dc.date.available2024-01-24T11:07:40Z
dc.date.issued2024-02
dc.identifier.issn0002-9149
dc.identifier.issn1879-1913
dc.identifier.urihttps://pearl.plymouth.ac.uk/handle/10026.1/21940
dc.description.abstract

This meta-analysis aimed to compare the midterm clinical outcomes of reimplantation versus remodeling techniques for valve-sparing aortic root replacement (VSARR) in patients with connective tissue disorders (CTDs). Studies were screened and identified after the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines from the PubMed, Web of Science, and Embase databases. Forest plots were produced using Review Manager 5.3 (Cochrane, UK). Studies comparing early and midterm clinical outcomes of reimplantation versus remodeling VSARR in patients with CTD with a mean age ≥18 years were included. The sensitivity analysis excluded studies and subgroups of patients that received ring or suture annuloplasty in addition to remodeling surgery. The study selection identified 9 eligible studies. After analysis of the study period and location for patient crossover, 7 retrospective studies consisting of 597 patients (301 reimplantation and 296 remodeling) were pooled. The pooling revealed no significant difference in postoperative mortality (estimated mean follow-up of 10.5 years) (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.30 to 1.48, I2 = 30%, p = 0.32), reoperation (OR 0.35, CI 0.04 to 3.30, I2 = 81%, p = 0.36), or occurrence of postoperative aortic regurgitation of ≥2 (OR 0.56, CI 0.31 to 1.02, I2 = 47%, p = 0.06). The sensitivity analysis excluding annuloplasty demonstrated improved mortality (OR 0.19, CI 0.06 to 0.64, I2 = 0%, p = 0.007) and decreased aortic regurgitation of ≥2 (OR 0.23, CI 0.10 to 0.53, I2 = 47%, p = 0.0005) in reimplantation VSARR. The rates of reoperation remained insignificant in the sensitivity analysis (OR 0.43, CI 0.05 to 3.53, I2 = 71%, p = 0.43). In conclusion, this meta-analysis has demonstrated no significant difference in the midterm clinical outcomes of reimplantation versus remodeling techniques of VSARR. The sensitivity analysis excluding studies and patient subgroups that received remodeling and annuloplasty suggests remodeling alone to be inferior to reimplantation in patients with CTDs. Further research is required to assess remodeling and annuloplasty against reimplantation in patients of this demographic because the current body of knowledge does not allow sufficient analysis.

dc.format.extent28-35
dc.format.mediumPrint-Electronic
dc.languageen
dc.publisherElsevier BV
dc.subjectaortic root aneurysm
dc.subjectconnective tissue disorder
dc.subjectreimplantation
dc.subjectremodeling
dc.subjectvalve- sparing aortic root replacement
dc.titleMidterm Clinical Outcomes of Reimplantation Versus Remodeling Valve-Sparing Aortic Root Replacement in Patients With Connective Tissue Disorders: A Meta-Analysis
dc.typejournal-article
dc.typeArticle
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/38104753
plymouth.volume213
plymouth.publisher-urlhttp://dx.doi.org/10.1016/j.amjcard.2023.11.066
plymouth.publication-statusPublished
plymouth.journalThe American Journal of Cardiology
dc.identifier.doi10.1016/j.amjcard.2023.11.066
plymouth.organisational-group|Plymouth
plymouth.organisational-group|Plymouth|Faculty of Health
plymouth.organisational-group|Plymouth|REF 2021 Researchers by UoA
plymouth.organisational-group|Plymouth|Users by role
plymouth.organisational-group|Plymouth|Users by role|Academics
plymouth.organisational-group|Plymouth|REF 2021 Researchers by UoA|UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group|Plymouth|Faculty of Health|School of Biomedical Sciences
plymouth.organisational-group|Plymouth|REF 2028 Researchers by UoA
plymouth.organisational-group|Plymouth|REF 2028 Researchers by UoA|UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
dc.publisher.placeUnited States
dcterms.dateAccepted2023-11-13
dc.date.updated2024-01-24T11:07:39Z
dc.rights.embargodate2024-1-27
dc.identifier.eissn1879-1913
rioxxterms.versionofrecord10.1016/j.amjcard.2023.11.066


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