title: Evolving Practice Trends of Aortic Root Surgery in North America.
abstract: BACKGROUND
  Aortic-valve sparing (AVS) techniques have emerged as alternatives to composite graft-valve replacement (CVR) for treatment of aortic root aneurysm. This study analyzed recent practice trends of aortic root surgery using the Society of Thoracic Surgeons database.
  
  
  METHODS
  From January 2000 through June 2011, 31,747, Overall patients received AVS (n=3,585/31,747; 11.3%) or CVR (n=28,162/31,747; 88.7%). A High-Risk Subgroup was defined as: age >75 years, endocarditis, aortic stenosis, dialysis, multi-valve surgery, valve reoperation, or emergency/salvage status, and high-risk patients were less likely to receive AVS (n=20,356/31,747 [64.1%]; 6% AVS; unadjusted operative mortality 10.5% AVS and 11.7% CVR). The remaining patients comprised a Low-Risk Subgroup, in which AVS was more common (n=11,388/31,747 [35.9%]; 21% AVS; unadjusted operative mortality 1.4% AVS and 3.1% CVR). Procedural changes over 3 equal time periods (P1-P2-P3) were evaluated by Cochran-Armitage trends analysis.
  
  
  RESULTS
  Compared to AVS, Overall CVR patients had worse baseline risk profiles and higher unadjusted operative mortality. In High-Risk patients, AVS mortality was comparable to CVR (10.5% vs 11.7%, p=0.19), but AVS mortality was lower in the Low-Risk group (1.4% vs 3%, p<0.0001). For P1/P2/P3, AVS percentages and trend p-values were: High-Risk (6%/6%/7%, p=0.26) and Low-Risk (12%/21%/25%, p<0.0001). CVR prosthesis type (mechanical/bioprosthesis/homograft) also changed: P1 (63%/22%/15%), P2 (58%/38%/4%), and P3 (53%/44%/3%) (all p<0.0001, except mechanical valves in High-Risk patients p=0.18).
  
  
  CONCLUSIONS
  Patients receiving CVR tended to have higher risk profiles. AVS increased over time in Low-Risk patients while bioprostheses increased in CVR. Favorable outcomes support the trend toward further expansion of AVS.
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA; Veterans Affairs Medical Center, Memphis, TN.
authors.forename: Manuel
authors.initials: M
authors.lastname: Caceres
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Yicheng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Vanderbilt University, Nashville, TN. Electronic address: jsrankinmd@cs.com.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: University of Maryland, Baltimore, MD.
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
keywords: Aortic Root; Aortic Valve Repair; Heart Valve.