title: Predictors of early and medium-term outcome of 200 consecutive aortic valve and root repairs.
abstract: OBJECTIVE
  Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamic parameters and avoidance of prosthetic valve-related complications. However, general acceptance of valve reconstruction may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair.
  
  
  METHODS
  Between 2003 and 2013, 200 consecutive patients (149 men, 51 women; mean age, 52.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques were used to assess major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing was used to identify associations between risk factors and major events.
  
  
  RESULTS
  Early mortality was 2% (4 patients), and early repair failure was 3% (6 patients). New York Heart Association functional class was found to be a risk factor for early mortality and morbidity (odds ratio, 3.3; P = .03), whereas crossclamp time and cardiopulmonary time were risk factors for early mortality (odds ratio, 1.04; 95% confidence interval, 1-1.07; P = .01 and odds ratio, 1.02; 95% confidence interval, 1-1.03; P = .02), respectively. Survival at a mean follow-up of 48.6 ± 34.3 months (median follow-up, 43.6 months; range, 17.8-78 months) was 94%, with a freedom from reoperation of 91%. Univariable risk factors for mortality were preoperative New York Heart Association functional class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, and complex leaflet repair. Freedom from repair failure was associated with aortic reimplantation.
  
  
  CONCLUSIONS
  Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory medium-term results obtained with valve reconstruction. Further analysis of these patient outcomes is necessary to draw definitive conclusions on operative techniques.
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland. Electronic address: marekjas@poczta.onet.pl.
authors.forename: Marek J
authors.initials: MJ
authors.lastname: Jasinski
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Gocol
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland.
authors.forename: Damian
authors.initials: D
authors.lastname: Hudziak
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Duraj
authors.affiliation: Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland.
authors.forename: Marek A
authors.initials: MA
authors.lastname: Deja
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012092:Replantation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome