title: Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery.
abstract: OBJECTIVE
  Early results after aortic valve-sparing root reconstruction are excellent. Longer-term follow-up, especially with regard to aortic valve function, is required for further judgment of these techniques.
  
  
  METHODS
  Between July of 1993 and September of 2006, 108 consecutive patients (mean age 53.0 +/- 15.8 years) underwent the Yacoub operation (group Y) and 83 patients underwent the David operation (group D). Innovative multilevel hierarchic modeling methods were used to analyze aortic regurgitation over time.
  
  
  RESULTS
  In general, aortic regurgitation increased with time in both groups. Factors associated with the development of a significant increase in aortic regurgitation were Marfan syndrome, concomitant cusp intervention, and preoperative aortic anulus dimension. In Marfan syndrome, the initial aortic regurgitation was higher in group Y versus group D (0.56 aortic regurgitation vs 0.29 aortic regurgitation, P = .049), whereas the mean annual progression rate of aortic regurgitation was marginally higher in group Y (0.132 aortic regurgitation vs 0.075 aortic regurgitation, P = .1). Concomitant cusp intervention was associated with a significant aortic regurgitation increase in both groups (P < .0001). There was a trend that smaller preoperative aortic annulus diameters in group D and larger diameters in group Y were associated with increased aortic regurgitation over time.
  
  
  CONCLUSIONS
  In regard to aortic regurgitation grade over time, patients with Marfan syndrome and a large preoperative aortic annulus diameter were better treated with the reimplantation technique, whereas those with a smaller diameter were better treated with the remodeling technique. Concomitant free-edge plication of prolapsing cusps was disadvantageous in both groups. Considering these factors may serve to improve the aortic valve longevity after valve-sparing aortic root surgery.
authors.affiliation: Clinic of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hanke
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Derek
authors.initials: D
authors.lastname: Robinson
authors.forename: Armin
authors.initials: A
authors.lastname: Gorski
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Sievers
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery; D008875:Middle Aged; D013536:Suture Techniques; D014463:Ultrasonography