title: Mortality characteristics of aortic root surgery in North America.
abstract: OBJECTIVE
  Aortic root surgery is transitioning to aortic valve sparing (AVS), but little is known about the relative early outcomes of AVS versus composite graft-valve replacement (CVR). This study assessed mortality differences for AVS versus CVR to guide future practice decisions.
  
  
  METHODS
  From January 2000 to June 2011, 31 747 patients had aortic root replacement with AVS (n = 3585; 11%) or CVR (n = 28 162; 89%). The cohort of Overall patients was divided into two subgroups: high-risk patients (n = 20 356; 6% AVS) having age >75 years, endocarditis, aortic stenosis, dialysis, multiple valves, reoperation or emergency/salvage status, and the remaining low-risk patients (n = 11 388; 21% AVS). Using logistic regression analysis, outcomes were presented as unadjusted operative mortality (UOM), risk-adjusted operative mortality (AOM) and adjusted odds ratio (AOR) for mortality.
  
  
  RESULTS
  Baseline characteristics for the Overall group (AVS versus CVR) were: mean age (52 vs 57 years), endocarditis (1 vs 11%), aortic stenosis (4 vs 36%), dialysis (1 vs 2%), multiple valves (7 vs 10%), reoperation (6 vs 17%) and emergency status (14 vs 12%) (all P < 0.0001). In high- and low-risk groups, baseline differences narrowed, and lower mortality was generally observed with AVS: (AVS versus CVR) UOM group Overall (4.5 vs 8.9%)*, group High-risk (10.5 vs 11.7%), group Low-risk (1.4 vs 3.1%)*; AOM group Overall (6.2 vs 8.6%), group High-risk (10.1 vs 11.7%), group Low-risk (2.2 vs 2.8%); AOR group Overall (0.59)*, group High-risk (0.62)*, group Low-risk (0.69). *P < 0.05.
  
  
  CONCLUSIONS
  Relative risk-adjusted mortality seemed comparable with AVS versus CVR in low- and high-risk subgroups. These data support judicious expansion of aortic valve repair in patients having aortic root replacement.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA Department of Cardiac Surgery, Veterans Affairs Medical Center, Memphis, TN, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Caceres
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Yicheng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Cardiac Surgery, Vanderbilt University, Nashville, TN, USA jsrankinmd@cs.com.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Division of Cardiac Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America / Q000453:epidemiology
keywords: Aortic root surgery; Aortic valve repair; Heart valve surgery