General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 1, pp 70–76 | Cite as

A systematic review and meta-analysis of mechanical vs biological composite aortic root replacement, early and 1-year results

  • Mohamad Bashir
  • Amer Harky
  • Saied Froghi
  • Benjamin Adams
  • Megan Garner
  • Prity Gupta
  • Aung Oo
  • Rakesh Uppal
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta



Composite aortic root replacement is a standard procedure for various aortic root pathologies. This systematic review was set to identify the postoperative outcomes for composite mechanical root replacement (mCRR) compared to composite biological root replacement (bCRR).


We systematically reviewed four major databases for all papers assessing outcomes in composite root replacement. Articles selected were chosen by two reviewers. Amongst our inclusion and exclusion criteria, all pediatric populations were excluded as were studies with a cohort less than 50 patients.


We identified seven studies that conformed to our inclusion criteria and incorporated 2240 patients. In-hospital mortality was higher but non-significant in the mechanical group (6.1 vs 4.2% respectively). There was no significant difference demonstrated in the risk of in-hospital stroke, late stroke and re-operation in either groups. Additionally, there was no significant difference in: endocarditis, 1-year mortality, 5-year mortality, mean cardiopulmonary or aortic cross-clamp time.


Composite mechanical root offers no superiority to composite biological root. There is a significant increase in the perioperative bleeding amongst composite mechanical root cohort. There is a need for further randomized control trail to assess the efficacy of either methods.


Aortic root Aneurysm Composite root Valve 



Mechanical composite root replacement


Biological composite root replacement


Composite aortic valve graft


Risk ratio


Mean weighted difference


Valve sparing replacement


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.


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Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  • Mohamad Bashir
    • 1
  • Amer Harky
    • 1
  • Saied Froghi
    • 2
  • Benjamin Adams
    • 1
  • Megan Garner
    • 1
  • Prity Gupta
    • 1
  • Aung Oo
    • 1
  • Rakesh Uppal
    • 1
  1. 1.Department of Cardiac Surgery, Barts Heart CentreSt. Bartholomew’s HospitalLondonUK
  2. 2.Department of Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK

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