title: Reexamining remodeling.
abstract: OBJECTIVE
  Root remodeling was proposed as valve-preserving root replacement to treat patients with aortic regurgitation and root aneurysm. The objective of this retrospective study was to review 18 years of experience with root remodeling and to identify predictors of valve durability.
  
  
  METHODS
  Between October 1995 and December 2013, root remodeling was performed in 747 patients. The aortic valve anatomy was tricuspid in 431 patients, bicuspid in 290 patients, and unicuspid in 26 patients. Aortic aneurysm was present in 688 patients, and 59 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade 0 to IV (grade 0, 1%; grade 1, 8%; grade 2, 26%; grade 3, 62%; grade 4, 3%; median, 3). All patients underwent root remodeling, concomitant operations were performed in 352 patients, and cusp repair was used in 690 procedures.
  
  
  RESULTS
  Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 91% at 15 years. Overall freedom from reoperation was 95% for tricuspid valves at 10 and 15 years, 89% for bicuspid aortic valves at 10 years (P = .006), and 83% for bicuspid aortic valves at 15 years. By multivariate analysis, the strongest risk factors for failure were an aortoventricular junction 28 mm or greater (hazard ratio, 1.43) and the use of a pericardial patch as part of cusp repair (hazard ratio, 6.24).
  
  
  CONCLUSIONS
  Root remodeling continues to be a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve geometry, reproducible restoration of aortic valve function can be achieved with good long term durability.
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany; Xanit Hospital Internacional, Malaga, Spain. Electronic address: h-j.schaefers@uks.eu.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.affiliation: Department of Anesthesia, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Raddatz
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmied
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Miura
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.affiliation: Departments of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D058385:Cardiac Valve Annuloplasty; D018572:Disease-Free Survival; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome