Valve-sparing root replacement versus Bentall procedure with bioprosthetic valves in patients with aortic insufficiency: a meta-analysis.

OBJECTIVE: The use of bioprosthetic valves in the Bentall procedure (bio-Bentall) has increased for its anticoagulant-free lifestyle benefits. Valve-sparing root replacement (VSRR) offers an alternative to the bio-Bentall with the preservation of native valves. However, comparative evidence between VSRR and bio-Bentall is scarce. This meta-analysis aims to address this knowledge gap. METHODS: A systematic review was conducted on databases from inception through December 2025. Studies reporting adjusted outcomes were included. The primary outcome was mid-term all-cause mortality and aortic valve reoperation. Secondary outcomes included perioperative mortality, stroke, reoperation for bleeding, new dialysis initiation, and permanent pacemaker implantation. Pooled analyses were performed using a random-effects model. RESULTS: Four observational studies with 1,468 patients (VSRR = 771, bio-Bentall = 697) were included. Mean follow-up durations ranged from 2.3 to 9.8 years. Except for lower stroke rates in the VSRR group, no significant differences were found in perioperative outcomes between the two groups. VSRR was associated with favorable mid-term mortality compared with bio-Bentall (adjusted hazard ratio [aHR] [95% confidence interval [CI]] = 0.59 [0.42–0.85]), and reduced aortic valve reoperation rates (aHR [95% CI] = 0.41 [0.24–0.71]). CONCLUSIONS: VSRR was associated with comparable perioperative outcomes to bio-Bentall, with favorable mid-term mortality and aortic valve reoperation rates. Larger studies with longer follow-up are necessary to elucidate the potential benefits of VSRR in aortic root surgery.