title: Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: early outcomes of the CAVIAAR multicentric prospective cohort study.
abstract: OBJECTIVE
  The study objective was to compare the 30-day outcomes of a standardized aortic valve repair technique (REPAIR group) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft (CVG group) replacement in treating aortic root aneurysms.
  
  
  METHODS
  A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospective cohort (131 in the CVG group, 130 in the REPAIR group) in 20 centers. The main end point is a composite criterion including mortality; reoperation; thromboembolic, hemorrhagic, or infectious events; and heart failure. Secondary end points were major adverse valve-related events. Crude and propensity score adjusted estimates are provided.
  
  
  RESULTS
  The mean age was 56.1 years, and the valve was bicuspid in 115 patients (44.7%). The median (interquartile range) preoperative aortic insufficiency grade was 2.0 (1.0-3.0) in the REPAIR group and 3.0 (2.0-3.0) in the CVG group (P = .0002). Thirty-day mortality was 3.8% (n = 5) in both groups (P = 1.00). Despite a learning curve and longer crossclamp times for valve repair (147.7 vs 99.8 minutes, P < .0001), the 2 groups did not differ significantly for the main criterion (odds ratio, 1.31; 95% confidence interval, 0.72-2.40; P = .38) or 30-day mortality (odds ratio, 0.99; 95% confidence interval, 0.28-3053; P = .99), with a trend toward more frequent major adverse valve-related events in the CVG group (odds ratio, 2.52; 95% confidence interval, 0.86-7.40; P = .09). At discharge, 121 patients (96.8%) in the REPAIR group had grade 0 or 1 aortic insufficiency.
  
  
  CONCLUSIONS
  A new standardized approach to valve repair, combining an expansible aortic annuloplasty ring with the remodeling technique, presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events. Analysis of late outcomes is in process for 3- and 10-year follow-ups.
authors.affiliation: Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France. Electronic address: emmanuel.lansac@imm.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lansac
authors.affiliation: Department of Cardiac Surgery, CHU Le Bocage, Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
authors.affiliation: Department of Cardiac Surgery, CHU A. Michallon, La Tronche, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Arnaud Crozat
authors.affiliation: Department of Cardiac Surgery, CHU A. Michallon, La Tronche, France.
authors.forename: Rachid
authors.initials: R
authors.lastname: Hacini
authors.affiliation: Department of Cardiac Surgery, CHU Charles Nicolle, Rouen, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Doguet
authors.affiliation: Department of Cardiac Surgery, CHU A. De Villeneuve, Montpellier, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Demaria
authors.affiliation: Department of Cardiac Surgery, CHU Pontchaillou, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Department of Cardiac Surgery, CHU Hopital Europeen Georges Pompidou, Paris, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Jouan
authors.affiliation: Department of Cardiac Surgery, Clinique Saint Gatien, Tours, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Chatel
authors.affiliation: Department of Cardiac Surgery, Institut Arnault Tzanck, Saint Laurent Du Var, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Lopez
authors.affiliation: Department of Cardiac Surgery, Hopital Brabois, CHU Nancy, Nancy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Folliguet
authors.affiliation: Department of Cardiac Surgery, CHU Pitié Salpetriere, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Acar
authors.affiliation: Department of Cardiac Surgery, CHU Pitié Salpetriere, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Department of Cardiac Surgery, CHU Pontchaillou, Rennes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Langanay
authors.affiliation: Department of Cardiac Surgery, Hopital Louis Pradel, CHU, Lyon, France.
authors.forename: Oliver
authors.initials: O
authors.lastname: Jegaden
authors.affiliation: Department of Cardiac Surgery, CHU Charles Nicolle, Rouen, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Bessou
authors.affiliation: Department of Cardiac Surgery, CHU A. De Villeneuve, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Albat
authors.affiliation: Department of Cardiac Surgery, CHU Hopital Europeen Georges Pompidou, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Latremouille
authors.affiliation: Department of Cardiac Surgery, CHU Hopital Europeen Georges Pompidou, Paris, France.
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Fabiani
authors.affiliation: Department of Cardiac Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.affiliation: Department of Cardiac Surgery, Clinique Belledone, Saint Martin d'Hères, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Fleury
authors.affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Pasquet
authors.affiliation: Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Debauchez
authors.affiliation: Department of Vascular Surgery, Hopital Foch, Suresnes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Di Centa
authors.affiliation: Assistance Publique Hôpitaux de Paris, Département d'Epidémiologie et Recherche Clinique, Hôpital Bichat, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057240:Patient Preference; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D057216:Propensity Score; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult