title: Aortic root surgery in the United States: a report from the Society of Thoracic Surgeons database.
abstract: OBJECTIVE
  The purpose of the present study was to evaluate the early clinical outcomes of aortic root surgery in the United States.
  
  
  METHODS
  The Society of Thoracic Surgeons database was queried to identify all patients who had undergone aortic root replacement from 2004 to early 2010 (n = 13,743). The median age was 58 years (range, 18-96); 3961 were women (29%) and 12,059 were white (88%). The different procedures included placement of a mechanical valve conduit (n = 4718, 34%), stented pericardial (n = 879, 6.4%) or porcine (n = 478, 3.5%) bioprosthesis, stentless root (n = 4309, 31%), homograft (n = 498, 3.6%), and valve sparing root replacement (n = 1918, 14%).
  
  
  RESULTS
  The median number of aortic root surgeries per site was 2, and only 5% of sites performed >16 aortic root surgeries annually. An increased trend to use biostented (porcine or pericardial) valves during the study period (7% in 2004 vs 14% in 2009). The operative (raw) mortality was greater among the patients with aortic stenosis (6.2%) who had undergone aortic root replacement, independent of age. Mortality was greater in patients who had undergone concomitant valve or coronary artery bypass grafting or valve surgery (21%). The lowest operative mortality was observed in patients who had undergone aortic valve sparing procedures (1.9%).
  
  
  CONCLUSIONS
  Most cardiac centers performed aortic root surgery in small volumes. The unadjusted operative mortality was greater for patients >80 years old and those with aortic stenosis, regardless of age. Valve sparing root surgery was associated with the lowest mortality. A trend was seen toward an increased use of stented tissue valves from 2004 to 2009.
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: sortiris-stamou@uiowa.edu.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Ky.
authors.forename: Mathew L
authors.initials: ML
authors.lastname: Williams
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Gunn
authors.affiliation: Hartford Hospital, Hartford, Conn.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hagberg
authors.affiliation: Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
authors.affiliation: Department of Cardiothoracic Surgery, Missouri Baptist Medical Center, St Louis, Mo.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D012955:Societies, Medical; D056346:Sternotomy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult