Conclusion
This study provides an overview of contemporary outcome after bioprosthetic aortic root replacement and demonstrates impaired survival and notable valve-related events, irrespective of the type of valve prosthesis. Thromboembolic events occur relatively frequent and may be associated with higher thrombogenicity of the biological valve, at least in the early postoperative period. This should be considered when choosing the most optimal treatment, especially in younger patients. Given the observed heterogeneity of the pooled study results, in-depth analysis of potential risk factors remains challenging. It requires a collective international effort employing uniform data definitions and high quality data collection, to push forward the knowledge on outcomes and provide clues toward optimization of treatment selection for patients requiring aortic root replacement (59). Nevertheless, this study provides comprehensive outcome and may be used as a benchmark to compare with other types of procedures (e.g. Bentall or valve-sparing procedures).