title: Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?
abstract: OBJECTIVE
  To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graft-valve replacement.
  
  
  METHODS
  From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.
  
  
  RESULTS
  In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation.
  
  
  CONCLUSIONS
  The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.
authors: Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
authors: Fernando de Azevedo
authors: Fde A
authors: Lamana
authors: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors: Ricardo Ribeiro
authors: RR
authors: Dias
authors: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors: Jose Augusto
authors: JA
authors: Duncan
authors: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors: Leandro Batisti de
authors: LB
authors: Faria
authors: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors: Luiz Marcelo Sa
authors: LM
authors: Malbouisson
authors: Departament of Morfology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
authors: Luciano de Figueiredo
authors: Lde F
authors: Borges
authors: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors: Charles
authors: C
authors: Mady
authors: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors: Fábio Biscegli
authors: FB
authors: Jatene
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D004812:Epidemiologic Methods; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D012086:Reoperation; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome