title: Results of matching valve and root repair to aortic valve and root pathology.
abstract: OBJECTIVE
  For patients with aortic root pathology and aortic valve regurgitation, aortic valve replacement is problematic because no durable bioprosthesis exists, and mechanical valves require lifetime anticoagulation. This study sought to assess outcomes of combined aortic valve and root repair, including comparison with matched bioprosthesis aortic valve replacement.
  
  
  METHODS
  From November 1990 to January 2005, 366 patients underwent modified David reimplantation (n = 72), root remodeling (n = 72), or valve repair with sinotubular junction tailoring (n = 222). Active follow-up was 99% complete, with a mean of 5.6 ± 4.0 years (maximum 17 years); follow-up for vital status averaged 8.5 ± 3.6 years (maximum 19 years). Propensity-adjusted models were developed for fair comparison of outcomes.
  
  
  RESULTS
  Thirty-day and 5-, 10-, and 15-year survivals were 98%, 86%, 74%, and 58%, respectively, similar to that of the US matched population and better than that after bioprosthesis aortic valve replacement. Propensity-score-adjusted survival was similar across procedures (P > .3). Freedom from reoperation at 30 days and 5 and 10 years was 99%, 92%, and 89%, respectively, and was similar across procedures (P > .3) after propensity-score adjustment. Patients with tricuspid aortic valves were more likely to be free of reoperation than those with bicuspid valves at 10 years (93% vs 77%, P = .002), equivalent to bioprosthesis aortic valve replacement and superior after 12 years. Bioprostheses increasingly deteriorated after 7 years, and hazard functions for reoperation crossed at 7 years.
  
  
  CONCLUSIONS
  Valve preservation (rather than replacement) and matching root procedures have excellent early and long-term results, with increasing survival benefit at 7 years and fewer reoperations by 12 years. We recommend this procedure for experienced surgical teams.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. svenssl@ccf.org
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Lillian H
authors.initials: LH
authors.lastname: Batizy
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Michael C
authors.initials: MC
authors.lastname: Moon
authors.forename: Richard S
authors.initials: RS
authors.lastname: D'Agostino
authors.forename: Edward M
authors.initials: EM
authors.lastname: Nadolny
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.forename: Donald F
authors.initials: DF
authors.lastname: Hammer
authors.forename: Richard
authors.initials: R
authors.lastname: Grimm
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
mesh_terms: D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011475:Prosthesis Failure; D012086:Reoperation; D012092:Replantation