title: Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement.
abstract: OBJECTIVE
  The study objective was to determine whether recurrent or residual mild aortic regurgitation, which occurs after valve-sparing aortic root replacement, progresses over time.
  
  
  METHODS
  Between 2003 and 2008, 154 patients underwent Tirone David-V valve-sparing aortic root replacement; 96 patients (62%) had both 1-year (median, 12 ± 4 months) and mid-term (62 ± 22 months) transthoracic echocardiograms available for analysis. Age of patients averaged 38 ± 13 years, 71% were male, 31% had a bicuspid aortic valve, 41% had Marfan syndrome, and 51% underwent aortic valve repair, predominantly cusp free margin shortening.
  
  
  RESULTS
  Forty-one patients (43%) had mild aortic regurgitation on 1-year echocardiogram. In 85% of patients (n = 35), mild aortic regurgitation remained stable on the most recent echocardiogram (median, 57 ± 20 months); progression to moderate aortic regurgitation occurred in 5 patients (12%) at a median of 28 ± 18 months and remained stable thereafter; severe aortic regurgitation developed in 1 patient, eventually requiring reoperation. Five patients (5%) had moderate aortic regurgitation at 1 year, which did not progress subsequently. Two patients (2%) had more than moderate aortic regurgitation at 1 year, and both ultimately required reoperation.
  
  
  CONCLUSIONS
  Although mild aortic regurgitation occurs frequently after valve-sparing aortic root replacement, it is unlikely to progress over the next 5 years and should not be interpreted as failure of the valve-preservation concept. Further, we suggest that mild aortic regurgitation should not be considered nonstructural valve dysfunction, as the 2008 valve reporting guidelines would indicate. We need 10- to 15-year follow-up to learn the long-term clinical consequences of mild aortic regurgitation early after valve-sparing aortic root replacement.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Stephens
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif.
authors.forename: David H
authors.initials: DH
authors.lastname: Liang
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: John-Peder Escobar
authors.initials: JP
authors.lastname: Kvitting
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Fabian A
authors.initials: FA
authors.lastname: Kari
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Fischbein
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Mitchell
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif. Electronic address: dcm@stanford.edu.
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 26.1; 35.1; AI; AR; BAV; CTD; CVG; IQR; MFS; Marfan syndrome; TAV; TTE; V-SARR; aortic insufficiency; aortic regurgitation; bicuspid aortic valve; composite valve graft; connective tissue disorder; interquartile range; transthoracic echocardiogram; trileaflet aortic valve; valve-sparing aortic root replacement