Does Preoperative Left Ventricular Ejection Fraction Impact the Results After Aortic Root Surgery? Decision-Making Between Aortic Valve-Sparing Techniques and Bentall Operation

Aim: Whether aortic valve sparing (valve sparing root replacement [VSRR]) and Bentall surgery differently affect myocardial dysfunction is not clear. This study aimed to clarify whether the type of aortic root surgery, in case of at least grade 2 aortic regurgitation associated with myocardial dysfunction, affects the outcomes. Method: Extraction from the Heart Valve Society aortic valve database (Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry [AVIATOR]) was performed and two groups of patients operated between July 2007 and December 2022 were identified: Group 1 including patients undergoing VSRR with ejection fraction (EF) ≤50% (n=279) and Group 2 including patients undergoing Bentall with EF ≤50% (n=46). All patients had at least grade 2 aortic regurgitation. Results: Similar cardiopulmonary bypass and cross-clamping time were reported. No statistically significant difference was reported between the groups in terms of postoperative bleeding, transfusion rate, reoperations, pacemaker rate implantation, ischaemic complications, and acute kidney injury. Follow-up mortality was similar between the groups, without any significant differences, and the weighted mixed-effect linear models showed improvement in EF in both groups; progressive inverse left ventricular remodelling is significantly higher in Group 2. Conclusions: While both techniques can improve left ventricular function in patients with reduced EF, the Bentall procedure offers marginally better results in terms of left ventricular inverse remodelling. However, the choice between Bentall and VSRR should ultimately be determined by the surgeon's expertise and familiarity with each technique.