title: Contemporary outcomes of surgery for aortic root aneurysms: A propensity-matched comparison of valve-sparing and composite valve graft replacement.
abstract: OBJECTIVE
  The study objective was to give an overview of the current state of the art of the surgical treatment of aortic root pathologies in a high-volume center.
  
  
  METHODS
  From May 1997 to January 2014, aortic root replacement was performed in 890 consecutive patients; 289 received a mechanical composite valved graft, 421 received a biologic composite valved graft, and 180 received a valve-sparing reconstruction. Propensity matching analysis was used to neutralize the differences in baseline characteristics between patients assigned to the different procedures.
  
  
  RESULTS
  Operative mortality was 0.2% (0% in the valve-sparing reconstruction group); the incidence of major postoperative complications was less than 0.5%. Predictors of adverse in-hospital outcome were age, nonelective operation, renal status, reoperation, New York Heart Association class, ejection fraction, and concomitant procedures. Five-year survival was 89.4%. Previous myocardial infarction, preoperative renal status, redo operation, and concomitant procedures were significantly associated with follow-up death. In the propensity-matched groups, the type of operation performed did not affect in-hospital and late outcome. Aortic reintervention rates at 5 years were 0% for the mechanical composite valved graft group, 2.4% for the biologic composite valved graft group, and 7.3% for the valve-sparing reconstruction series.
  
  
  CONCLUSIONS
  In the current era, aortic root replacement can be performed with low perioperative risk in high-volume aortic centers. The type of operation performed does not affect early or late survival. Although the mechanical composite valved graft remains the gold standard for durability, the biologic composite valved graft and valve-sparing reconstruction are excellent options for those who cannot take or want to avoid long-term anticoagulation.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Monica
authors.initials: M
authors.lastname: Munjal
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Avgerinos
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY. Electronic address: lngirard@med.cornell.edu.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
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*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009519:New York City; D057216:Propensity Score; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aorta; prosthesis; surgery; valves