VALVE-SPARING OPERATIONS VERSUS COMPOSITE AORTIC ROOT REPLACEMENT (BENTALL PROCEDURE) FOR ACUTE TYPE A AORTIC DISSECTION: A LITERATURE REVIEW
DOI:
https://doi.org/10.11603/2414-4533.2026.1.16093Keywords:
aortic dissection, acute aortic dissection, ATAAD, Bentall procedure, David procedure, valve-sparing operations, acute aortic regurgitation, complicationsAbstract
The aim of the work: Acute Type A Aortic Dissection (ATAAD) is a cardiothoracic emergency requiring immediate intervention. The aim of this article is to compare valve-sparing operations (VSO) versus composite aortic root replacement (Bentall procedure) for acute Type A Aortic Dissection.
Materials and Methods. This article analyzes research results, comparative meta-analyses, and current clinical guidelines (EACTS/STS 2024) to compare the two surgical strategies. For a long time, the Bentall operation was the most optimal for AAD complicated by aortic regurgitation (AR). However, the latter burdens the patient (often young, in the case of AAD) with the risks associated with the prosthesis: the need for anticoagulant therapy when using a mechanical valve prosthesis or the risk of structural degeneration of the bioprosthesis. Valve-sparing surgery (VSR) offers an alternative to avoid these complications.
Results. It is important to clearly distinguish between surgical techniques. The terms “valve-sparing surgery” and “Valve-Sparing Root Replacement” are often used synonymously, but they describe procedures of different complexity, indications, and duration. To this end, we distinguish four main categories of root surgery for GRA. Comparative meta-analyses suggest VSOs (David procedure) are associated with lower mortality compared to the Bentall procedure. However, Propensity Score Matching (PSM) studies demonstrate that in patients with a comparable risk profile, both procedures provide equivalent 10-year survival rates and freedom from reoperation.
Conclusions. Current clinical guidelines recommend an individualized approach: the David procedure is prioritized for stable, young patients with repairable valve anatomy, while the Bentall procedure remains the gold standard for patients with hemodynamic instability, non-repairable valve anatomy, and limited institutional VSO experience.
Received: 30.12.2025 | Revised: 12.01.2026 | Accepted: 20.02.2026
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