Is aortic valve-sparing operation or replacement with a composite graft the best option for aortic root and ascending aortic aneurysm?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is better to preserve the aortic valve in patients with aortic root or ascending aortic aneurysms. Altogether 380 papers were found using the reported search, of which 23 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All the studies identified are retrospective. Sixteen papers reported a 10-year reoperative-free survival from 54% to 98% for valve-sparing operations and 67-81% for replacement operations in two further studies. Six papers reported their 10-year freedom from re-operation as 75-97% for valve-sparing operations. Our findings suggest that the results of both techniques are excellent and comparable, and the operating surgeon may safely make his decision as to which technique to select based on patient factors and his own experience without compromising the long-term outcomes of the patient.