Comparison of Outcomes between Valve-Sparing Root Replacement and the Bentall Procedure in Acute Stanford Type A Aortic Dissection: A Single-Center Retrospective Cohort Study in South Korea
- 1School of Medicine, Tokyo Women’s Medical University Tokyo Japan
- 2Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine Seoul Korea
Abstract
Background: Comparative evidence for valve-sparing root replacement (VSRR) versus the Bentall procedure in acute Stanford type A aortic dissection (ATAAD) remains limited. We compared early and long-term outcomes between these procedures.
Methods: We retrospectively analyzed patients with ATAAD who underwent emergency aortic root intervention at Asan Medical Center (1994–2022), comparing VSRR with the Bentall procedure. Stabilized inverse probability of treatment weighting (IPTW) was applied using 6 prespecified clinically relevant covariates. Cox models analyzed all-cause mortality and the composite outcome, and Fine–Gray competing risk models analyzed stroke, infective endocarditis (IE), hemorrhagic events, and reoperation.
Results: Among 82 patients undergoing aortic root intervention (VSRR, n=17; Bentall procedure, n=65), covariate balance improved after IPTW, with standardized mean differences <0.20 for prespecified covariates. Early outcomes showed no clear between-group differences. During a median follow-up of 6.02 years (interquartile range, 1.22–15.42 years), no significant between-group differences were found in all-cause mortality (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.29–2.33; p=0.718) or the composite outcome (HR, 0.70; 95% CI, 0.32–1.53; p=0.368). Competing risk analyses showed no clear differences in stroke (subdistribution HR [sHR], 0.90; 95% CI, 0.15–5.37; p=0.908), IE (sHR, 0.30; 95% CI, 0.004–21.34; p=0.582), hemorrhagic events (sHR, 0.68; 95% CI, 0.07–6.61; p=0.743), or reoperation (sHR, 0.13; 95% CI, 0.004–4.80; p=0.269).
Conclusion: In this single-center ATAAD cohort requiring aortic root intervention, VSRR and the Bentall procedure showed no clear differences in adjusted outcomes. Longer follow-up and larger multicenter studies exploring anatomic and operative variables are warranted.
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BibTeX
@article{oshiro2026comparison,
title = {{Comparison of Outcomes between Valve-Sparing Root Replacement and the Bentall Procedure in Acute Stanford Type A Aortic Dissection: A Single-Center Retrospective Cohort Study in South Korea}},
author = {Saori Oshiro and Kitae Kim and Hong Rae Kim and Ho Jin Kim and Joon Bum Kim},
journal = {Journal of Chest Surgery},
year = {2026},
month = nov,
doi = {10.5090/jcs.26.031},
url = {https://doi.org/10.5090/jcs.26.031},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Comparison of Outcomes between Valve-Sparing Root Replacement and the Bentall Procedure in Acute Stanford Type A Aortic Dissection: A Single-Center Retrospective Cohort Study in South Korea
AU - Saori Oshiro
AU - Kitae Kim
AU - Hong Rae Kim
AU - Ho Jin Kim
AU - Joon Bum Kim
PY - 2026
DA - 2026/11/05
JO - Journal of Chest Surgery
DO - 10.5090/jcs.26.031
UR - https://doi.org/10.5090/jcs.26.031
AB - Background: Comparative evidence for valve-sparing root replacement (VSRR) versus the Bentall procedure in acute Stanford type A aortic dissection (ATAAD) remains limited. We compared early and long-term outcomes between these procedures. Methods: We retrospectively analyzed patients with ATAAD who underwent emergency aortic root intervention at Asan Medical Center (1994–2022), comparing VSRR with the Bentall procedure. Stabilized inverse probability of treatment weighting (IPTW) was applied using 6 prespecified clinically relevant covariates. Cox models analyzed all-cause mortality and the composite outcome, and Fine–Gray competing risk models analyzed stroke, infective endocarditis (IE), hemorrhagic events, and reoperation. Results: Among 82 patients undergoing aortic root intervention (VSRR, n=17; Bentall procedure, n=65), covariate balance improved after IPTW, with standardized mean differences <0.20 for prespecified covariates. Early outcomes showed no clear between-group differences. During a median follow-up of 6.02 years (interquartile range, 1.22–15.42 years), no significant between-group differences were found in all-cause mortality (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.29–2.33; p=0.718) or the composite outcome (HR, 0.70; 95% CI, 0.32–1.53; p=0.368). Competing risk analyses showed no clear differences in stroke (subdistribution HR [sHR], 0.90; 95% CI, 0.15–5.37; p=0.908), IE (sHR, 0.30; 95% CI, 0.004–21.34; p=0.582), hemorrhagic events (sHR, 0.68; 95% CI, 0.07–6.61; p=0.743), or reoperation (sHR, 0.13; 95% CI, 0.004–4.80; p=0.269). Conclusion: In this single-center ATAAD cohort requiring aortic root intervention, VSRR and the Bentall procedure showed no clear differences in adjusted outcomes. Longer follow-up and larger multicenter studies exploring anatomic and operative variables are warranted.
SN - 2765-1606
SN - 2765-1614
ER -