Aortic Root Replacement: A Comparison of Valve- Sparing Procedures With Mechanical Valve Replacement in Patients With Marfan Syndrome

Background: Historically, surgical replacement of the aortic root in Marfan syndrome patients involved replacing the native valve with a mechanical valve resulting in the need for life-long anticoagulation. Recently, surgeons have developed procedures that spare, rather than replace the aortic valve during aortic root replacement. The goal of this systematic review is to compare valve-sparing aortic root replacement with traditional aortic root replacement with mechanical valves, and evaluate the evidence using the GRADE system. Methods: An extensive review of the literature was conducted using Medline-Ovid, PubMed, and Cinhal. Three articles that met the inclusion criteria were included in the review. Results: Similar intraoperative and early mortality rates were demonstrated between aortic root replacement with AVR and AVS. Two studies showed increased late morbidity of thromboembolic events associated with AVR compared to AVS. Follow-up times between the two groups in each study differed drastically, making it difficult to draw final conclusions regarding long-term outcomes. Conclusions: Although aortic root replacement with either AVR or AVS provides a low risk of early mortality, there are insufficient long-term data on late mortality that support recommending valve-sparing (AVS) procedures over valve-replacing (AVR) procedures at this time. After applying the GRADE system to the review, the overall quality of the evidence was determined to be low.